What are the Steps in Healthcare Revenue Cycle Management

The concept of healthcare revenue cycle management is largely used by a majority of the hospitals or clinics for successfully managing all the administrative/clinical data. RCM also called ‘revenue cycle management’ is a procedure through which the healthcare practices can streamline the overall medical billing facilities, right from scheduling patient’s appointment to the final payment.

In short, revenue cycle management manages all the essential financial elements that are involved in a business. The claim care revenue cycle management covers the cycle of organizing the administrative data (personal details of patients, treatment codes, name of insurer) and the detailed billing/financial information. It is  all about capturing, managing, and collecting the patient data (right from registration to the final bill payment).

Gathering Patient Details Before Their Arrival

It is an important step for both parties. Gathering the details beforehand will help the patients to eliminate the need of waiting in long queues and save their time accordingly. Whereas, from the hospital’s point of view, creating a hassle-free process for the patients will encourage them to pay the bills on time. It is a kind of pre-registration wherein the primary information is collected such as patient name, demography details, medical history, insurance details, etc., and accomplishing maximized customer satisfaction.

Patient Registration

This stage validates or authenticates the originality of the patient’s data that has been collected in the initial phase (pre-registration). At times, the patient might enter inaccurate data or there might be any sort of errors in the details registered in the form. Rectifying these errors will take some time and it might create a delay for the hospitals to receive the reimbursement from the payers.

Insurance Eligibility Verification

Once the appointment or registration gets fixed, the next step is to verify the insurance eligibility of the patients. Often, this was implemented through a phone call, as you need to contact the insurance firm or log onto the website of the payers. But with the contemporary RCM systems, one can achieve automated verification of the insurance eligibility, thereby, eliminating the manual authentication.

Charge Capture

The service charges from the bill are captured and the details are submitted to the insurance providers. It is a highly important stage in the healthcare revenue cycle management process. The right charge capture service will enable the hospitals or clinics to receive complete reimbursement from the payers. This term is largely known as ‘revenue integrity’ in the medical industry.

Reviewing the Utilization

One of the primary motives behind this stage of reviewing is to affirm that the insurance plan covers the medical needs/services of the patients. It will also help the insurance companies to reduce the cost and contribute to determining if the treatment of the patient is appropriate.

Medical Coding

Generally, the worldwide accepted medical codes are used by the coding specialists and are applied to the patient’s records. After the claim submission, the insurers tend to make the best use of the codes for determining the reimbursement amount. With the rising health services, there has been an immense need for the translation of procedure descriptions or patient details/conditions into numeric codes. Though patients might not be aware of these codes, it is highly beneficial for the hospitals.

Claim Submission

Once the coding is done successfully, the next stage involves the submission of the claims by the hospitals to the insurance companies. It will enable the processing of the payment as per the rules mentioned in the contract. On the other hand, if an error takes place in the process, the claim won’t be sent to the insurance company. Well, this can delay the process of receiving the reimbursement payment from the end of the insurance companies.

Patient Collection

It manages the patient’s balance and offers them a payment option. This stage includes assisting the patient in getting a deeper understanding of the charges and how to set the payment plans. It doesn’t matter if you are using printed or digital statements, facilitating the patients to make a payment via an online platform is one of the crucial ways of generating revenue.


Reporting is one of the most important stages in revenue cycle management. It has the ability to make or break your healthcare practices. You can use powerful and accurate reporting tools for managing the medical services, analyzing the accounts receivable, and creating easy reporting.

The concept of healthcare revenue cycle management is evolving constantly. With the integration of an effective RCM, healthcare-based firms such as hospitals or clinics can reduce operational expenses and boost the customer-satisfaction. MediBilling Experts is the top-notch and well-recognized offshore-based revenue cycle management service provider, boosting patient interaction and speeding up revenue generation. For further details about our service, contact us at [email protected]

Post by Jessica Dawson

Leave a Reply

Your email address will not be published. Required fields are marked *