Small description about Revenue Cycle Management

To deliver the best medical service is not enough to earn money. To run a successful medical practice, the billing process from the healthcare providers must be accurate and efficient.

Revenue cycle management is the process used by healthcare providers to charge accurately and on time to receive all payments from insurance companies on time. The process starts with the contact or encounter from the patient with the health system and ends when the last payment has been paid.

Because of the complexity of the revenue cycle management process and the regulatory oversight, it is common that healthcare providers turn their revenue cycle management to third companies to handle this complex process with specialized agents and proprietary technologies to manage healthcare provider revenue cycles.

Compliance with medical coding regulations is an important aspect of revenue cycle management. Higher revenues and decreases claim denials from insurance companies occur when optimal coding compliance, also a medical practice can avoid regulatory penalties.

Steps from the Revenue Cycle Management are:

Registration: where the patient provides all the information required to fill the insurance company bill (per the ANSI 837 5010 standards and requirements). This information usually contains the patient’s full name, date of birth, address, email, phone number, marital status, gender, social security number, emergency contact, release of information, primary insurance provider information.

Medical Coding: 

Charge capture: when the physicians record an episode of care into a medical claim system for billing purposes.

Coding: Coding specialists translate the physicians’ record into universally accepted medical codes that insurance companies use to determine reimbursement amounts.


Claims submission: based on set rates for each medical procedure code, health providers send a claim requesting payment from insurers. In order to avoid rejected claims, accuracy is essential.

Insurer communications: It is important that billing managers communicate regularly with insurers to find out patients’ coverage levels and collect reimbursements without errors or denials.

Payment collections: After insurance companies have paid requested bills, healthcare providers bill patients for any remaining balance. During this step, it is important to be really clear, to help patients understand charges and setting up payment plans.

All this Revenue Cycle Management is like a land full of explosive mines. A misspelled word, a wrong code, or a birthday date can delay or deny payments from insurers. To reduce human error in claims submission processes, healthcare data professionals use practice management software to automatically scan for mistakes and send error alerts or outsource the revenue cycle management to companies that can give 24/7 support and service.

Although the International Statistical Classification of Diseases and Related Health Problems (ICD), is being updated regularly, it is better to have a company dedicated to keeping up with ICD and insurance company policies.

About 90% of claim denials are preventable, preventing claim denial can result in more than $5 million in additional revenue for an average hospital, according to Becker’s Hospital Review. Revenue Cycle Management tools can be used to generate reports that provide detailed finances and performance indicators.

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