Navigating Revenue Cycle Management


Today, healthcare is one of the utmost priorities for everyone, including you. In fact, since it has become so extensive, there are billions of dollars circulating in the industry.

That being said, business owners in the healthcare world are always looking for improved ways to manage revenue. Luckily, through revenue cycle management, providers are able to facilitate bill collections.

Navigating Revenue Cycle Management

But, as a patient, have you ever wondered what the best ways are to deal with a lengthy medical revenue cycle? Now you have come to the right place!
Continue reading to learn about our guide.

Brief Overview

Revenue cycle management (RCM) is a strategic process that health care organizations use to track patient data and payments. The goal of RCM is to optimize cash flow and improve patient satisfaction.

To do this, RCM systems track every step of the patient journey from appointment scheduling to billing and payments. The end result is a healthier bottom line for the organization and a better experience for the patient.


You must schedule or preregister for the most appropriate first step. It enables a medical practice to collect information such as insurance and eligibility.

Those will be sent to the provider’s practice management system. This notifies the provider of the patient’s coverage, deductible, co-insurance, and co-payment.

A well-coordinated schedule will reduce wait times and common billing errors. They can also improve their workflow and ensure that all tasks are completed on time.


When you register a patient, you create a medical record for that individual. This record contains vital information about the patient’s medical history and insurance coverage. This also ensures that the patient’s address, phone number, birth date, and guarantors are all correct.

The medical staff uses this to provide care for the patient. On the other hand, the billing staff may use it to submit claims for reimbursement from the patient’s insurance company.

If you will skip this part, you’re unlikely to be paid for their services. Thus, there is a risk of financial consequences.

Upfront Charge Collection

Up-front charge collection is a key element of medical revenue cycle management. Medical practices can reduce their accounts receivable and improve their cash flow. This can also help practices avoid write-offs and reduce the need for collections.

Besides, there is a variety of ways to do this. It can be automated so that data from the records flow automatically into the practice management billing side. The other option is to manually fill in the form at the front desk or send it to medical billing.

Both approaches have benefits and drawbacks, as charges can be missed in either case. Ancillary services are a known overcharge that results in revenue loss.

To avoid incomplete charges, make sure you are thoroughly coding and submitting charges to the insurance carrier.

Claim Submission

Claim submission is the process of submitting insurance claims to payers and collecting payments. Because there are so many different payers with different requirements, this process can be very complex and time-consuming.

Moreover, the CPT code and diagnosis code will all be examined by the team. They will inquire whether the diagnosis will support the procedure.

It’s crucial to double-check that the claim form has all the necessary documents attached before submitting it. It should be sent to the payer, along with any extra required documentation, as part of the claim submission process.

Remittance Processing

Medical revenue cycle management includes the crucial but overlooked task of remittance processing.

An explanation of benefits (EOB) from the insurance provider is usually sent to the provider when a patient pays their bill. To properly post the payment and close the account, the provider must next match the remittance to the corresponding EOB.

If the provider is using manual techniques, this could be prone to mistakes. A good revenue cycle management system will automate the processing of remittances. As a result, making management much easier for the provider.

Insurance Follow-up

Insurance follow-up is the next stage of the medical revenue cycle management. Here, it examines both what has been paid for and what has not.

However, there are often delays in payments from insurers, which can put a strain on providers’ cash flow. Follow-up with insurers is a critical step in the RCM process and can help to ensure that providers are paid on time.

Thus, determining the structure is a big component of insurance follow-up. You may consider asking about specific carriers, billing staff, and how insurance is handled.

Patient Collections

Patient collections are the most challenging step in the revenue cycle process. When a patient is in your office is the ideal time to collect payment on laboratory billing services. Because of this, it is better that front desk personnel receive training in collecting at the time of service.

For co-payments and deductibles, there should be a standard policy. This is the best way to avoid the collections backlog growing out of control.

On top of that, there should be a daily statement cycle. This will allow you to improve the speed of your revenue cycle and speed up your cash flow. Your patients will still receive one statement every 30 days, but statements will be sent out more often.

Also, once claims have been decided, any unpaid balance on an account will be sent to the collections. To collect the full amount owed, medical billing staff should generate bills, send them to patients, and collaborate with them.

Easily Navigate Your Revenue Cycle Management

Efficient revenue cycle management is critical for any business. By using the tips in this article, you can streamline your process and ensure that you are efficiently managing your revenue.

This will free up time and resources that can be better spent elsewhere in your business. Implementing these tips can help you take control of your revenue cycle and improve your bottom line.

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