The Key Steps and Benefits of Revenue Cycle Management (2024)

The Key Steps and Benefits of Revenue Cycle Management (1)

Revenue cycle management is an invaluable part of successful healthcare organizations. Without an efficient billing department, your practice could lose out on thousands of dollars in payer reimbursem*nts, patient payments, and other streams of revenue that your practice depends on to continue running.

Understanding and executing excellent Revenue Cycle Management is an integral component of the success of your entire organization. The steps of the revenue cycle and the benefits of quality Revenue Cycle Management are listed below.

Revenue Cycle Management:

Revenue Cycle Management encompasses the entire revenue cycle from the time of an appointment all the way through the time the patient’s bill is paid in full. This involves deciding whether or not to outsource RCM services to a qualified vendor, implement unified software so that your practice can run more effectively, and choosing what features are important to you and will help you optimize your bottom line.

Step 1: Pre-Authorization and Eligibility Verification

The first step in revenue cycle management is pre-authorization and registration. This is the point at which you gather the patient’s insurance and financial information. Automated eligibility verification tools used at this time benefit you as the provider by giving insight into how you will be paid for different services and benefits patients by preparing them for their financial responsibility. This step within revenue cycle management can be improved with price transparency and insurance verification tools found in fully integrated practice management and medical billing solutions.

Step 2: Services and Charge Capture

Once services have been rendered to the patient, the second step of revenue cycle management is to transcribe services rendered into billable charges in a process called charge capture. This step of revenue cycle management is crucial to the claims process as it is the moment you assign a medical billing code to the claim. With quality medical billing software, your team can gain access to important coding tools that help you code more accurately, ensuring timely reimbursem*nt. Claims scrubbing technology will help make sure each claim is coded accurately, the first time. This can save hundreds and sometimes thousands of dollars in claim re-work and administrative costs associated with claim rejections.

Step 3: Claim Submission and Denial Management

The next step in revenue cycle management is submitting a claim. Once you have completed the charge capture process, it is then up to you to submit the accurately coded claim to the payer. This step in your revenue cycle management process can be improved using a practice management software and RCM services vendor to track your claims in real-time, stopping them in their tracks before they have a chance to be denied. This makes sure your organization is submitting clean claims as high as 99%, earning the fastest payment possible. By outsourcing your billing to an RCM vendor that utilizes a qualified practice management solution, you can automate this task and give your team peace-of-mind, knowing the claim is on the way to the payer.

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Should a claim be denied for any reason, the combination of your vendor and billing software helps you resubmit it as quickly as possible. This step in your revenue cycle management can also be improved by utilizing important features in a quality medical billing solution to easily identify common errors in your coding so that your team can course correct and prevent future denials from taking place.

Step 4: Payment

Once your claim has been reviewed by the patient’s insurance, the payer reimbursem*nt will be on the way and the out-of-pocket cost is then posted for the patient to pay. With an integrated billing solution, your patients can view and pay their bills right in their patient portal. Your integrated practice management solution can also equip you to remind patients of their bills and prompt them to make payments, leading to more on-time and in-full payments. This step should also include quality collections services from your RCM service vendor, helping you optimize patient payments while getting your patients on track to recover from medical debt.

Step 5: Quality Reporting

While the receiving of the payment is technically the last step in the process of revenue cycle management, your practice also needs quality reporting technology that helps you stay on track and avoid costly mistakes. Quality reporting tools in your medical billing software can help you easily identify common mistakes through your revenue cycle management process that is causing money to slip through the crack. Your software and vendor can help you fix these areas and secure your bottom line. Easily reduce days in A/R by identifying trends and roadblocks in your revenue cycle.

To learn more about an integrated practice management and billing solution that can help your practice optimize its revenue cycle management process, click here.

The Key Steps and Benefits of Revenue Cycle Management (2)

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The Key Steps and Benefits of Revenue Cycle Management (2024)

FAQs

What are the steps of revenue cycle management? ›

The seven steps of revenue cycle include preregistration, registration, charge capture, claim submission, remittance processing, insurance follow-up and patient collections.

What are the benefits of revenue cycle management? ›

The Benefits of a Successful RCM Process
  • Reduced time commitment. ...
  • Reduced errors and redundancy. ...
  • Reduced costs. ...
  • Fewer denials. ...
  • Reduced administrative burden and faster collection process. ...
  • Improved patient experience.

What are the 4 steps in the revenue cycle? ›

What is revenue cycle management can be broken down into four steps.
  • Step 1: Insurance Verification. ...
  • Step 2: Working with Your Patient and Creating a Patient Superbill. ...
  • Step 3: Claims Submission and Denial Management. ...
  • Step 4: Payment and Reporting.
4 Aug 2022

What are the first 3 steps of RCM? ›

3 Phases of RCM: Use Best Practices to Improve Performance
  • Revenue Cycle Phase 1: Setting Appointments & Capturing Patient Demos.
  • Revenue Cycle Phase 2: Capturing Charges & Submitting Claims.
  • Revenue Cycle Phase 3: Remittance Posting, Collections & Data Analysis.
  • How does your practice optimize the revenue cycle?

What are the five key areas for revenue cycle improvement? ›

Five steps to improve a practice's revenue cycle management...
  • Focus on the patient. ...
  • Consolidate systems. ...
  • Focus on collecting payments early. ...
  • Give patients alternative ways to pay. ...
  • Focus on improving systems on the back-end.
22 May 2017

What are the 5 steps required in revenue recognition? ›

The FASB has provided a five step process for recognizing revenue from contracts with customers:
  • Step 1 – Identify the Contract. ...
  • Step 2 – Identify Performance Obligations. ...
  • Step 3 – Determine the Transaction Price. ...
  • Step 4 – Allocate the Transaction Price. ...
  • Step 5 – Recognize Revenue.

What are the five benefits of revenue management? ›

The benefits of revenue management include a better ability to predict customer wants and needs, a more effective pricing strategy, an expansion of available markets and a stronger relationship between the company divisions.

What is the importance of revenue management? ›

Revenue management is crucial to build direct bookings. In addition, it can be a useful tool to be more efficient, boost sales, get higher profits margins, and thus save intermediary costs.

What are the 3 main concepts used in revenue management? ›

The discipline of revenue management combines data mining and operations research with strategy, understanding of customer behavior, and partnering with the sales force.

What is the main purpose of the revenue cycle? ›

The goal of revenue cycle management is to identify any points of friction in the provider's revenue cycle in order to resolve them. With proper revenue cycle management, care providers can maximize their claim reimbursem*nts and increase their revenue.

What are the 4 steps of the accounting process? ›

The first four steps in the accounting cycle are (1) identify and analyze transactions, (2) record transactions to a journal, (3) post journal information to a ledger, and (4) prepare an unadjusted trial balance. We begin by introducing the steps and their related documentation.

What are the 4 main requirements associated with revenue recognition? ›

In this instance, revenue is recognized when all four of the traditional revenue recognition criteria are met: (1) the price can be determined, (2) collection is probable, (3) there is persuasive evidence of an arrangement, and (4) delivery has occurred.

What is the most important part of the revenue cycle management? ›

Experienced Staff- An experienced staff is probably the most important component of maintaining an efficient revenue cycle. This staff must be skilled and knowledgeable in healthcare changes, medical billing and coding, insurance claims process and the challenging denial appeals process.

What is the last step in the revenue cycle? ›

The last step in the revenue cycle is cash collections. The accounts receivable department must know when customers pay their invoices, yet segregation of duty controls dictate that the collection and recording functions be kept separate from each other.

What are 2 key measures of revenue? ›

Total Revenue and Marginal Revenue

There are two main measures of revenue that companies use to gauge sales.

What are the key players in revenue cycle roles? ›

9 most in-demand revenue cycle roles in healthcare
  • Registrars (59.6 percent)
  • Billing specialists (54.7 percent)
  • Patient follow-up (42.4 percent)
  • Front-office staff (38.7 percent)
  • Central scheduling (37.8 percent)
  • Denial specialists (37.1 percent)
  • Authorization staff (36.1 percent)
  • Claims specialists (35.2 percent)
17 Mar 2022

What are revenue management strategies? ›

Revenue Management is the application of analytics that predicts consumer behaviour at the micro-market level to optimise product availability and price to maximise revenue growth. The primary aim of a revenue management strategy is selling the right product to the right customer at the right time for the right price.

What is step 5 of the accounting cycle? ›

Step 5: Worksheet

Analyzing a worksheet and identifying adjusting entries make up the fifth step in the cycle. A worksheet is created and used to ensure that debits and credits are equal. If there are discrepancies then adjustments will need to be made.

What is the five step method? ›

The 5-step method consists of (1) Listen, reassure, and explore concerns; (2) Provide relevant, specific, and targeted information; (3) Explore coping resources; (4) Discuss social support; and (5) Discuss and explore further needs (Copello, Templeton, et al., 2010a). ...

What is 5 step approach? ›

Step 1: Identify the problem. Step 2: Review the evidence. Step 3: Draw a logic model. Step 4: Monitor your logic model. Step 5: Evaluate the logic model.

What is the benefit of revenue? ›

The main benefit of a revenue budget is that it requires looking into the future. The revenue budget should contain the assumptions made about the future and the details about the number of units to be sold, the expected selling prices, and so on.

What are the benefits of revenue management in front office? ›

Revenue management services benefit hotels by streamlining processes, save man hours, reduce expenses and provide a better experience to the guests.

What are the benefits of increased revenue? ›

By accelerating the rate of revenue growth you generate more profits faster which enables you to (a) take more profits, (b) reinvest in your business, (c) create new sources of revenue, (d) merge or acquire another business, and (e) improve the value of your business.

What is the first step in the revenue management process? ›

The first step in revenue cycle management is pre-authorization and registration. This is the point at which you gather the patient's insurance and financial information.

What is revenue management example? ›

The most common example of how Revenue Management is executed is in the businesses of Hotel Management and the Airline Industry. The primary source of revenue for hotels is found in their room rates. The revenue generated from the bookings is a simple multiplication of price and volume booked.

What are 4 types of revenue? ›

Rent revenue. Dividend revenue. Interest revenue. Contra revenue (sales return and sales discount)

What is revenue cycle management in simple words? ›

Revenue cycle management (RCM) is the financial process, utilizing medical billing software, that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance.

What is the most important step in the accounting cycle? ›

The fundamental concepts above will enable you to construct an income statement, balance sheet, and cash flow statement, which are the most important steps in the accounting cycle.

Which action is a key step in the accounting cycle? ›

The key steps in the eight-step accounting cycle include recording journal entries, posting to the general ledger, calculating trial balances, making adjusting entries, and creating financial statements.

What are the 10 steps to the accounting cycle and why is each important? ›

There are ten steps in an accounting cycle, which include analyzing transactions, journalizing transactions, post transactions, preparing an unadjusted trial balance, preparing adjusting entries, preparing the adjusted trial balance, preparing financial statements, preparing closing entries, posting a closing trial ...

What is revenue recognition process? ›

Revenue recognition is a generally accepted accounting principle (GAAP) that stipulates how and when revenue is to be recognized. 1. The revenue recognition principle using accrual accounting requires that revenues are recognized when realized and earned–not when cash is received.

What is revenue recognition method? ›

Different revenue recognition methods include:

Sales-basis method: Revenue is recognized at the time of sale, which is defined as the moment when the title of the goods or services is transferred to the buyer. Completed-contract method: Revenues and expenses are recorded only at the end of the contract.

What are the requirements of revenue? ›

The annual total revenue requirement (TRR, total product cost) for a system is the revenue that must be collected in a given year through the sale of all products to compensate the system operating company for all expenditures incurred in the same year and to ensure sound economic plant operation.

What is a revenue cycle example? ›

Revenue Cycle of a Manufacturer

For example, if the JKL Corporation makes widgets and promotes those widgets through a sales staff, a salesperson may contact potential customers. If the salesperson gets an order, the normal procedure might be to check company records to ensure that sufficient inventory is on hand.

What are the 7 questions of RCM? ›

The seven questions that need to be asked for each asset are:
  • What are the functions and desired performance standards of each asset?
  • How can each asset fail to fulfill its functions?
  • What are the failure modes for each functional failure?
  • What causes each of the failure modes?
  • What are the consequences of each failure?

How many types of RCM are there? ›

There are two type of reverse charge scenarios provided in law. First is dependent on the nature of supply and/or nature of supplier. This scenario is covered by section 9 (3) of the CGST/SGST (UTGST) Act and section 5 (3) of the IGST Act.

How many steps are there in RCM implementation? ›

RCM in 7 steps

While there are several different methods for implementing a Reliability Centered Maintenance (RCM) process, most methods include seven basic steps.

What are the 9 steps of the revenue cycle? ›

The Medical Revenue Cycle in 9 Steps
  • Step 1: Pre-Registration. ...
  • Step 2: Registration. ...
  • Step 3: Charge Capture. ...
  • Step 4: Utilization Review. ...
  • Step 5: Coding. ...
  • Step 6: Claim Submission. ...
  • Step 7: Remittance Process. ...
  • Step 8: Insurance Follow-Up.
5 Jan 2022

What is the first step of revenue cycle management? ›

The first step in revenue cycle management is pre-authorization and registration. This is the point at which you gather the patient's insurance and financial information.

How many stages are there in revenue lifecycle? ›

The revenue lifecycle is a concept that helps business owners and managers understand the complete process of generating income for an organization. It consists of five stages, all of which are important to the success of the organization's bottom line.

What is the most important step of revenue cycle? ›

The first and most vital step in the revenue cycle process, preregistration allows the medical practice to capture demographic information, insurance information and eligibility in real time through a clearing house, often while the patient is still on the phone.

What is full revenue cycle management? ›

Revenue Cycle Management (RCM) refers to the process of identifying, collecting and managing the practice's revenue from payers based on the services provided. A successful RCM process is essential for a healthcare practice to maintain financial viability and continue to provide quality care for its patients.

What is the purpose of the revenue cycle? ›

Revenue cycle management (RCM) refers to an institution's financial management process that helps track, identify, collect, and manage incoming payments. This helps businesses foster financial transparency within the company and charge patients the correct amount for the services and healthcare they receive.

What is revenue cycle model? ›

Revenue cycle models take marketing to the next level. They model all the stages of your entire revenue funnel—from when you first interact with a lead all the way until the lead is a won customer.

What are the 5 lifecycle stages? ›

The 5 stages of the product life cycle
  • The product life cycle is the progression of a product through 5 distinct stages—development, introduction, growth, maturity, and decline. ...
  • Market research plays an integral role in each stage of the product life cycle. ...
  • The first stage in the product life cycle is development.

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