Medical Billing

medical revenue cycle management

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:

Do Verify Patient InformationDon’t Ignore Insurance Eligibility
Do Submit Claims PromptlyDon’t Delay Billing Processes
Do Conduct Regular Coding AuditsDon’t Neglect Coding Updates
Do Follow Up on Outstanding ClaimsDon’t Overlook Denied Claims
Do Use Advanced RCM TechnologiesDon’t Rely on Manual Processes
Do Train Staff RegularlyDon’t Assume Compliance
Do Monitor Key Performance Indicators (KPIs)Don’t Ignore Performance Metrics
Do Ensure Clear Communication with PatientsDon’t Ignore Patient Billing Queries
Do Regularly Review Payer ContractsDon’t Accept Underpayments
Do Stay Updated on Healthcare RegulationsDon’t Overlook Compliance Requirements
Do Implement Data-Driven Decision MakingDon’t Rely on Gut Feeling
Do Maintain Accurate Financial RecordsDon’t Overlook Financial Reconciliation
Do Provide Clear Billing Statements to PatientsDon’t Use Complex Medical Jargon in Bills
Do Optimize Patient SchedulingDon’t Allow Unnecessary Scheduling Gaps
Do Implement Robust Security MeasuresDon’t Neglect Data Security

Step 2: Attendance

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

key role players in rcm

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

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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

role players in rcm

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

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    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 NumberKPI NameDescriptionTarget Benchmark
    Step 1Patient Registration Accuracy RatePercentage of accurately registered patients>95%
    Step 2Patient Check-In CompliancePercentage of patients checked in accurately and on time>98%
    Step 3Coding Accuracy RatePercentage of accurately coded claims>98%
    Step 4Claim Submission Turnaround TimeAverage time taken to submit claims post-treatment<5 days
    Step 5Claim Status Resolution TimeAverage time taken to follow up and resolve claim status<10 days
    Step 6Claim Return RatePercentage of claims returned due to errors or additional information<5%
    Step 7Claim Rejection RatePercentage of claims rejected by payers<5%
    Step 8Collection RatePercentage of revenue collected from claims submitted>95%
    Step 9Billing Accuracy RatePercentage of accurate bills generated and sent to patients>98%
    Step 10Process Completion TimeAverage 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.