10 Steps Of Medical Revenue Cycle Management (RCM)

Medical revenue cycle management process involves the revenue reimbursement to healthcare providers in return for their services, either from the government or either from private organizations.

The process helps medical facilities generate revenue through efficient RCM management. RCM also ensures to remove any defect that can lead to a claim denial or eventually revenue loss.

The medical revenue cycle management process starts from the scheduling of patient consultations to the recovery of reimbursement. The cycle involves the following 10 steps:

Step 1: Patient Registration

At first, the healthcare staff registers the patient consultation in the RCM program, where all of the patient’s details are filled in.

Some dos and don’ts of RCM to keep in mind from very first stage are:

Dos	Don’ts
Do Verify Patient Information	Don’t Ignore Insurance Eligibility
Do Submit Claims Promptly	Don’t Delay Billing Processes
Do Conduct Regular Coding Audits	Don’t Neglect Coding Updates
Do Follow Up on Outstanding Claims	Don’t Overlook Denied Claims
Do Use Advanced RCM Technologies	Don’t Rely on Manual Processes
Do Train Staff Regularly	Don’t Assume Compliance
Do Monitor Key Performance Indicators (KPIs)	Don’t Ignore Performance Metrics
Do Ensure Clear Communication with Patients	Don’t Ignore Patient Billing Queries
Do Regularly Review Payer Contracts	Don’t Accept Underpayments
Do Stay Updated on Healthcare Regulations	Don’t Overlook Compliance Requirements
Do Implement Data-Driven Decision Making	Don’t Rely on Gut Feeling
Do Maintain Accurate Financial Records	Don’t Overlook Financial Reconciliation
Do Provide Clear Billing Statements to Patients	Don’t Use Complex Medical Jargon in Bills
Do Optimize Patient Scheduling	Don’t Allow Unnecessary Scheduling Gaps
Do Implement Robust Security Measures	Don’t Neglect Data Security

Step 2: Attendance

The patient itself comes to take a consultation, where appointment details are collected.

Step 3: Coding

Health staff then identifies the medical RCM code according to the patient’s info.

Step 4: Claim Submission 

When the reimbursement application is ready, the claim is submitted to the reviewer electronically. 

Step 5: Status Tracking

After the claim submission, its status is constantly checked to analyze if there’s any rejection by the reviewer.

Step 6: Claim Return

The provider reviews the claim. Either he provides the reimbursement or either he denies the claim.

Step 7: If The Provider Rejects The Claim

If your medical billing claim has been denied, the revenue provider returns it by determining a problem that your staff is required to solve.

Step 8: Revenue Collection

If the claim is approved, reimbursement is made by the provider in the medical billing program.

Step 9: Bill Process

After receiving the reimbursement, the staff sends the medical bill to the patient. But mostly it is done automatically with the help of technology. 

Step 10: Complete The Process

At last, health staff makes sure that patients get and pay their bills on time.

Following are some key performance indicators (KPIs) for each RCM step:

Step Number	KPI Name	Description	Target Benchmark
Step 1	Patient Registration Accuracy Rate	Percentage of accurately registered patients	>95%
Step 2	Patient Check-In Compliance	Percentage of patients checked in accurately and on time	>98%
Step 3	Coding Accuracy Rate	Percentage of accurately coded claims	>98%
Step 4	Claim Submission Turnaround Time	Average time taken to submit claims post-treatment	<5 days
Step 5	Claim Status Resolution Time	Average time taken to follow up and resolve claim status	<10 days
Step 6	Claim Return Rate	Percentage of claims returned due to errors or additional information	<5%
Step 7	Claim Rejection Rate	Percentage of claims rejected by payers	<5%
Step 8	Collection Rate	Percentage of revenue collected from claims submitted	>95%
Step 9	Billing Accuracy Rate	Percentage of accurate bills generated and sent to patients	>98%
Step 10	Process Completion Time	Average time taken to complete the entire RCM process	<45 days

These were the 10 steps involve in medical revenue cycle management that makes the process easier to conduct.