Health revenue cycle management is an integral part of your practice. Without proper documentation and records, you risk losing thousands of dollars in patient payments, payer reimbursements, and other streams of revenue that you practice.
Therefore, understanding and practicing the steps of revenue cycle management is essential for your organization’s success. The steps that’ll assist in revenue cycle management are listed below.
Revenue Cycle Management Steps for Profitable Practice

Health revenue cycle management is an integral part of your practice. Without proper documentation and records, you risk losing thousands of dollars in patient payments, payer reimbursements, and other streams of revenue that you practice. 

Therefore, understanding and practicing the steps of revenue cycle management is essential for your organization’s success. The steps that’ll assist in revenue cycle management are listed below. 

Revenue Cycle Management Steps for Profitable Practice 

Revenue cycle management includes the entirety of a patient’s visit to your clinic. Everything is managed by a revenue cycle from the time the patient checks in till the bill is paid in full. However, it’s up to the clinic to decide whether they’ll purchase a unified software or outsource their services to a qualified vendor. Whatever the case, it’s important to know about revenue cycle management steps. 

Pre-Authorization and Eligibility Verification 

The first step of the health revenue cycle is collecting relevant information about the patient. This includes the patient’s insurance details and financial information. This information is collected mostly while the patient is on call with your practice. The pre-authorization phase sets the financial tone and prevents any unexpected payment debates. 

Charge Capture 

After the patient’s information is collected, the revenue cycle process moves to charge capture. It is the phase where the services provided by the medical institute are translated into bills and payments. Each bill is assigned a medical code through medical billing software attached to the claim and sent to the patient’s insurance providers. 

With robust medical billing software, this revenue cycle management process is handled with care. Often time wrong codes are attached to claims sent to insurance companies. 

As a result, unwanted delays cause the medical institution’s revenue to be tied up. To minimize this error, medical institutes outsource their revenue cycle process. 

Claim Submission and Denial Management

The third and most crucial step of RCM is claim submission and denial management. This step ensures correct claims are sent to the patient to ensure quick payments. Most medical institutions outsource their RCM entirely to focus on their core competencies rather than spend time tracking claims. 

As a result, RCM vendors submit 99% accurate claims. Moreover, RCM vendors prevent claims denial by stopping the claim in its tracks if they believe it will be denied. This saves time and mitigates charges the medical institution would face against wrong claims. 

If your claim is denied for some reason, you can quickly send a new one with the combination of your billing software and vendor. This step in the RCM can be improved by integrating quality features in your medical billing software that captures prevalent and future errors in coding claims.

Remittance Processing 

After the claims have been sent, they get remittances back. During this stage, allowable are discussed. Allowables are the services allowed by the insurance company to the medical institution. 

There is a list of allowables, and the insurance company will pay for all the medical procedures on it. The provider and carrier negotiate the contract, and at one point, the insurance company will determine what services they’ll pay for. 

A common mistake medical institutions face during the remittance process is the “post and go” dilemma. Since everything is done electronically, medical institutions forget about remittances. This oversight results in monetary loss for the practice because when the final books are reconciled, a substantial deficit is noted that has no explanation. 

Payment

Once your claim is completed, it’s sent to the insurance company, and the payment is disbursed. The patient will pay the remaining payment, and your RCM vendor will ensure you receive full payment. 

For instance, your patients can view their dues through their portal, and they’ll be reminded to make their payments on time. Outsourcing your RCM services can remove the unnecessary stress of payment collection from your head. Plus, your payments will be on time, and you’ll have plenty of time to focus on treating patients. 

Reporting 

While getting your payments is the final stage of the revenue cycle management process, RCM vendors don’t stop here. They share quality reports that paint a clear picture of your financial position. Plus, quality reporting removes costly errors and prevents money from slipping through the cracks unnoticed. You’ll have all the information about your finances securing your bottom line. 

The Bottom Line 

Revenue cycle management isn’t easy when looking after a medical clinic and treating patients. At J3 Revenue cycle management, we are more than just a software seller. We manage your revenue so that you can focus on other things. For more information, you can visit our website https://j3rcm.com/ or call us by dialing (954) 544 2706.