Revenue Cycle Management (RCM)

Revenue Cycle Management (RCM)

 

  • Revenue cycle management (RCM) is the financial process, utilizing medical billing software that healthcare facilities & providers use to track patient care episodes from registration and appointment scheduling to the final payment.
  • Healthcare revenue cycle management is the financial process that facilities use to manage the administrative and clinical functions associated with claims processing, payment, and revenue generation. The process encompasses the identification, management, and collection of patient service revenue.
  • End-to-end revenue cycle management and medical billing services helping hospitals and healthcare organizations improve their revenue cycle operations and cash flows
  • RCM App (Software) viz. Epic, Allscripts, McKesson, Gateway Medical or NextGen connect Providers to Payers to accurately and seamlessly determine patients’ insurance status, benefits levels, financial assistance eligibility, potential secondary payers, medical necessity and utilization management rules and prior authorization requirements
  • The RCMs Billing & Collections tools enable Hospitals & Providers accept pre-payments and point-of-service payments as well as submit claims electronically (Via EDI -837) to payers after services are rendered
  • The RCMs charge-capture, coding and compliance tool ensures the submission of clean claims for all reimbursable services, resulting in fewer rejections, denials and appeals
  • The Revenue Cycle Management (RCM) solutions are flexible, scalable and customizable, allowing provider organization to successfully add payer contracts / LOBs for growing business
  • The revenue-cycle analytics tool help generates real-time revenue-cycle performance metrics that let Providers track accounts receivable and immediately address problem areas that could negatively affect provider organization’s cash flow
  • These RCM Apps also help make cost/prices for Provider Services transparent to patients upfront and then assess patients’ ability and willingness to pay their out-of-pocket share of their medical expenses
  • The RCM Global Benchmark Metrics 
  1. Decrease AR by – 35%
  2. First Pass Clean Claims Rate  (FPCCR) – 97%
  3. Net Collection up by  - 98%
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