Revenue Cycle Management
Revenue Cycle Management (RCM) is the process that manages claims processing, payment and revenue generation.
Our RCM team manages the whole claims cycle including claims creations, claims processing and payment and revenue generation.
The revenue cycle begins at appointment booking and ensuring insurance eligibility has been confirmed prior to patient arrival for their visit. This continues through clinical documentation, verifying that a visit note is coded correctly for services rendered by a provider. Finally, the claims creation, submission and management process ensures that reimbursement for claims is readily received, minimizing cost for resubmission due to claims denials.
Understanding the total revenue cycle is the first step toward achieving maximum revenue for your practice. It is important to note that “achieving maximum revenue” does not mean you are overcharging or trying to manipulate payers. It simply means you are smarter about the services you provide and understand how to get payment from your payers the first time while minimizing the costs and effort associated with getting paid. While a clinic’s ultimate purpose is to provide care for patients, neglecting to closely monitor the business of the clinic, hinders you from being able to provide care at all.
Traditionally, clinics have looked at the billing office as a “back office” function. This view implies the revenue cycle begins after the patient leaves. When you look at the true revenue cycle in its entirety, it becomes clear that every member of the office affects your ability to be paid in full. Just like patient care, it is vital that the focus of the revenue cycle be prevention, not just treatment. So, what does that look like in your office?