Revenue Cycle Management (RCM) by definition refers to administrative and clinical functions that support capturing, managing, and collecting revenue from patient services. This process encapsulates the way in which revenue cycle processes flow and affect each other. In order for the cycle to perform in a predictable and sustainable manner, each process must be performed correctly. For this reason, preventing early problems in the cycle can go a long way to avoiding significant issues down the line, including those that would necessitate costly revenue recovery.

Terms Associated with RCM

Revenue Cycle Management features multiple terms specific to its functioning. The following can help you navigate RCM materials:

  • Charge Capture: At this stage, documented services are electronically or manually translated into billable fees.

  • Claim Submission: Using a universal claim form for payment, billable fees are submitted at this stage to the insurance company.

  • Coding: This includes the transformation of medical diagnosis descriptions and procedures into universal medical code numbers that can be processed by the insurance company.

  • Patient Collections: At this stage, patient balances are collected and payment arrangements made.

  • Pre-registration: Here, all registered information is collected, including eligibility, benefits, and authorizations, all prior to the patient arriving for procedures as an inpatient or outpatient.

  • Registration: At this stage, comprehensive data elements, required to establish a Medical Record Number, are collected. When correctly executed, this step satisfies regulatory, financial, and clinical requirements.

  • Remittance Processing: This term refers to posting or applying payments or adjustments to the assigned accounts, as well as rejects.

  • Third-Party Follow-Up: Here, billing specialists pursue collections from insurers after all initial claims have been filed.

  • Utilization Review: Finally, at this point in the process, the necessity, appropriateness, and efficiency of medical services and facilities, including regular reviews of admissions, length of stay, performed services, and referrals, are evaluated.

With these terms in mind, you’ll have a better understanding of the value of each step in the medical billing cycle.


Why Is Revenue Cycle Management Important?

Proper revenue cycle processes can prevent unnecessary loss of revenue through CMS-rejected claims, many of which will not be resubmitted if turned down. In order to make sure your office is implementing proper RCM practices, contact a medical billing company with a strong track record for maintaining exceptional procedures. At MBA Medical, we’re happy to answer any and all of your questions about billing procedures, training, communication, and workflow. We look forward to hearing from you – contact us today!