Critical Areas of RCM

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Critical Areas of RCM

Revenue cycle management is a critical tool for the survival and growth of a healthcare institution. It ensures that services rendered are successfully converted into revenue. According to Manley and Satiani (2009), the main aspects of RCM include; payer contracting, appointment scheduling, registration process, capturing charges, billing patients and payers, and conducting follow-up on account receivables. Each of these steps is crucial to the revenue cycle.

Payer contracting involves getting accreditation from payers before rendering health services. It is crucial to have agreements in place to ensure you have a valid contract with the payers. This also gives the physician a chance to evaluate the reimbursement rates.

Appointment scheduling allows the provider to identify services that are not covered by third payers. Therefore, the patient should acknowledge the responsibility to pay in full for the services. It also allows the provider to get valuable information which is essential for practice.

Registration of patients involves establishing a new file ad updating information on past clients. This is essential because patients change insurance plans, names or jobs over time. This stage allows the provider to verify the insurance information and confirm whether the plan covers the services sought.

Capturing and coding charges in the next element of RCM. This step involves the provider documenting all services rendered to generate accurate billing information. The billing system should ensure that all services are captured in the bill.

The next step is billing the patient and insurance. This is where the provider sends a claim for payment. It is crucial to ensure all information is documented correctly to reduces cases of denial by the payer.

The last step is a follow-up on account receivables. In many cases, the claim is not paid promptly or correctly, thus requiring follow-up to ensure the claim is settled. RCM system should ensure the collection of all claims and determine how to reinforce the claims. Sometimes, collection agencies can be used to collect accounts on behalf of the provider.




Manley, R., & Satiani, B. (2009). Revenue cycle management. Journal Of Vascular             Surgery50(5), 1232-1238.