Importance of Revenue Cycle Management in Healthcare


Healthcare Revenue Cycle Management

One of the most pressing issues in the healthcare industry is revenue collection. Lawmakers keep a close eye on medical billing and revenue collections of the sector. Legal ramifications and higher regulations in the industry make it difficult for healthcare providers to collect their dues properly. Additionally, many healthcare organizations use outdated technology to maintain their books. The combination of poor technology and the involvement of insurance providers further complicates the billing process.

Revenue cycle management is undoubtedly the most important part of the healthcare sector’s income. Estimates suggest that this industry will grow by 12.4 percent by 2026. To sustain the organization and avoid losses, let’s understand revenue cycle management techniques in detail.

Revenue Cycle Management Process in Healthcare

This management cycle involves all the processes related to the finances of the healthcare organization. It includes costs associated with each patient’s care process from the beginning to the end. It starts with the patient’s first encounter or the appointment scheduling process and ends with collecting the amount for the provided services.

With the patient scheduling process, organizations can collect as much information as they can from the patients. Proper data collection at this stage is vital to file insurance claims, verify eligibility, or process bills in the future. Medical staff must also ensure their patients have legitimate insurance on papers that can pay for these services. Swifter and precise claims transmission allow more flexibility in handling patient care.

After providing medical services, organizations must manage past accounts and handle accounts receivables effectively. Efficiently handling these tasks helps healthcare providers get paid faster and put the money to good use. If healthcare providers fail to deal with accounts receivables, they must prepare themselves to handle bad debt and uncollectible patient records responsibly. By keeping the patient accounts up to date, firms can create a better cycle by scheduling the next visits and offering reminders.

Best Practices for Revenue Cycle Management

If you want to optimize your RCM, we hope these practices give you a good idea of how you should tackle major issues. Here are some suggestions we find valuable: –

  1. When the patient schedules an appointment, your admin staff must manage the appointment, verify insurance eligibility, and establish a patient’s account efficiently.
  2. Encourage pre-registration at the time of appointment to process payments faster. 
  3. During the above stage, staff must include medical history and insurance coverage in the account.
  4. Focus on getting more information that’s accurate in the scheduling and registration phase itself.
  5. Once the doctor attends to the patient, swiftly create and submit claims. 
  6. Identify the proper treatments provided and use the right medical codes to record them. Carefully file these claims to avoid denials that postpone payments.
  7. Send these claims in time to private or government insurance for quick reimbursement. 
  8. Emphasize backend processes like payment posting, collections, claims denial management, and statement processing.
  9. About 65 percent of claims are never refiled. Avoid losing your pay and reprocess your claims within a week.
  10. If insurance doesn’t cover any procedure, get in touch with the patient to collect payments.

Keep your overall goal towards quicker payment processing and getting paid in full. The healthcare sector usually receives payments quite late and after a lot of struggle.

Healthcare Revenue Cycle Management Challenges

While healthcare providers love RCM systems, it’s not a one-stop solution for all your payment issues. There are many challenges to using these systems for healthcare too. Some of them include: –

  • Constantly evolving healthcare guidelines, regulations, and compensation models.
  • Difficulty in maintaining a stable revenue stream due to a variety of reasons.
  • Collecting payments within the stipulated time frame.
  • Not getting reimbursed immediately because of the payer’s cash crunch.
  • Maintaining the right balance between being firm about debt collection and not driving patients away because of it.
  • Healthcare firms lose up to 8 percent in revenue because of denials. Hence, it’s important for them to track claims processing diligently and proactively follow up with the insurance providers.
  • Training the staff to reduce the error rate as much as possible.

Benefits of Healthcare Revenue Cycle Management

Here’s how RCM systems benefit healthcare organizations in the long-term: –

  1. Simplifies tracking the billing and collection processes effectively.
  2. Provides a single destination for all revenue collection procedures.
  3. Eases communication with the electronic health record and accounting systems.
  4. Links all patient information and provides easy access and visibility.
  5. Bridges the gap between the accounting and medical sides of the healthcare sector.
  6. Preserves and manages past billing records properly.
  7. Reduces the time between offering services and receiving payments.
  8. Automates some functions that required manual intervention previously.
  9. Saves healthcare practitioners time.
  10. Takes charge of all administrative tasks well.
  11. Saves time and effort by minimizing denied claims and enabling online payments.
  12. Stores claim process data in a single place and improve data integrity.
  13. Can help in revenue cycle optimization.
  14. Helps organizations buy a useful analytics software and use platforms to determine or analyze revenue goals.

How to be Successful in Healthcare Revenue Cycle Management?

Here’s how you can maximize your revenue cycle to process claims faster and get paid quicker: –

  • Always verify insurance eligibility before you register your patients. Prominent studies state that eligibility issues cause the most claims denials.
  • Always keep the expenses lower than the revenue to allows some flexibility.
  • Improve communication with the payers and educate them on the payment process.
  • Use charitable donations to keep strength in finances.
  • Strengthen your front-end tasks and proactively collect all data needed for reimbursement.


90% of all claim denials are preventable. Proactive sorting out your payments will help you to improve your finances significantly and ease many difficulties. Hence, you need efficient revenue cycle management in your healthcare organization to gain revenue quicker and plan better for the future.


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