The 12 Essential Steps of Revenue Cycle Management

Revenue cycle management (RCM) is critical to the success of any healthcare organization, but it can be complex and overwhelming. Learn the 12 essential steps of RCM, from patient scheduling to billing and payments to claim denials and beyond, with tips for reducing denials and improving cash flow.

Revenue cycle management (RCM) is a vital component of any healthcare organization. It ensures timely and accurate payment for services rendered, impacting everything from patient satisfaction to a practice’s cash flow and financial health. But the complete RCM process is much more extensive and cumbersome than many providers realize — and it’s rife with opportunities for error.

Let’s explore all 12 integral steps of the RCM process to understand the importance of having a bulletproof process for each step, no matter the complexity of the claim involved.

Meet the Revenue Cycle

As a layered aspect of practice management, RCM is contingent on quality and accurate information. Beyond creating a bill for services rendered, providers must pay close attention to every part of the revenue generation process.

Below are the 12 steps of true revenue cycle management, from start to finish:

• Patient scheduling: This first step includes scheduling the patient’s appointment, which helps them receive appropriate care in a timely manner.
• Benefit and eligibility verification: Verifying a patient’s insurance benefits and eligibility is critical in determining the level of coverage and out-of-pocket costs.
• Preauthorization: Obtaining preauthorization for certain services can minimize claim denials and maximize reimbursement.
• Patient visit: During the patient’s visit, healthcare providers document the care administered, which is then used to support billing claims.
• Medical transcription: This step involves converting the services rendered into written, billable documentation, allowing for medical coding (classification).
• Medical coding: Assigning the appropriate codes to the services provided ensures claims are submitted correctly and accurately to maximize reimbursement.
• Charge capture/claims generation and submission: Charges for services rendered are captured and submitted to the appropriate payers to become an outstanding bill.
• Payment posting: Posting payments includes applying payments to the appropriate accounts for accurate financial recordkeeping.
• Secondary billing: Some situations require a secondary payer to cover a portion of the cost. Identifying the secondary payer upfront is often a function of preauthorization.
• Patient billing: Patient billing consists of generating and sending bills to patients for any remaining balances after insurance payments are applied.
• Accounts receivable: This step involves receiving revenue and reconciling it with claims.
• Denial management: In the event of denied claims, providers must remediate and resubmit the claim so they are adequately paid for the services rendered.

The Process Has Room for Improvement

Any process is only as viable as the sum of its parts. For the revenue cycle, this means bringing integrity to each crucial step. By considering every step, providers can streamline RCM, reduce billing errors and denials, and improve cash flow. Ultimately, this leads to increased revenue, enhanced patient satisfaction, and better financial health for the practice.

Learn how to maximize every step of the revenue cycle at trubridge.com.