Revenue-cycle-management

Revenue Cycle Management (RCM) in medical billing is the end-to-end financial process healthcare providers use to track patient care from the initial appointment or service through the final payment of the balance.

It ensures that providers get paid for the services they deliver, by managing all the steps between patient registration and claim reimbursement.

Key Stages of Revenue Cycle Management (RCM):

1. Patient Registration & Verification

a. Collect patient demographics and insurance details.

b. Verify insurance eligibility and coverage before service.

2. Charge Capture

a. Document all medical services and procedures.

b. Convert them into standardized medical codes (CPT, ICD-10, HCPCS).

3. Claim Submission

a. Submit claims electronically (or paper, if required) to insurance companies.

4. Claim Management

a. Track claim status.

b. Correct and resubmit denied or rejected claims.

5. Payment Posting

a. Record payments received from insurance companies and patients.

b. Apply adjustments (contractual obligations, write-offs, etc.).

6. Patient Billing & Collections

a. Send bills for remaining patient responsibility (co-pays, deductibles).

b. Manage collections if unpaid.

7. Denial Management & Appeals

a. Investigate claim denials.

b. Resubmit or appeal denied claims to maximize reimbursement.

8. Reporting & Analytics

a. Monitor financial performance (A/R days, denial rates, collection rate).

b. Identify bottlenecks and improve cash flow.