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What Is Revenue Cycle Management in Healthcare?


Revenue cycle management (RCM) is a robust discipline featuring financial processes, medical billing software, patient records, and payments. Modern clinics, hospitals, and private practices can leverage healthcare revenue cycle management software to streamline revenue collection. RCM unifies the business and clinical aspects of healthcare. The software captures healthcare data, including patients’ personal details, insurance providers, and treatments.

How Revenue Cycle Management Works in Healthcare

When an insured patient visits a healthcare provider to get treatment, the provider will collect various data. Insurance information will determine whether the patient is covered for specific treatment or services. If the treatment is covered, the provider will offer care and code it according to the set coding instructions. The healthcare provider can then send the care summary to relevant medical insurance carriers to receive payment for their service.

Healthcare revenue cycle management may seem simple, but dealing with insurance providers can present problems. Sometimes the insurance covers a portion of the bill, and the rest has to be paid by the patient. Healthcare RCM software is designed to streamline the process and make sure providers receive their due payments. The software can help healthcare providers run efficiently and profitably by collecting all payments on time.

Who Needs Healthcare RCM?

Healthcare revenue cycle management is for any medical practitioner with a business or independent practice. If you offer healthcare services and accept patients with insurance coverage, you should consider RCM solutions. Healthcare RCM software can streamline scheduling, verification, charge capture, medical coding, and claims submission. 

RCM software also improves payment reconciliations, secondary insurance, patient payments, audits, controls, unpaid claims recovery, accounts receivables, and business intelligence. If you run a healthcare business or private practice, RCM companies and software can help you optimize operational outcomes. RCM aims to enable healthcare providers to recoup their deserved revenue efficiently, punctually, and with ease.

Benefits of RCM in Healthcare

Revenue cycle management covers pre-authorization and verification, charge capturing, coding, claims submission, payment collections, and medical service review. Using RCM software helps to identify and resolve errors, streamline processes and reduce administrative burden. The top benefit of revenue cycle management in healthcare is streamlining revenue collection.

RCM in healthcare maps out the patient journey. The discipline covers everything from when the patient contacts the healthcare provider to when they pay their medical bill. Understanding the process allows the healthcare provider to identify and streamline issues. Other benefits include preventing healthcare/patient fraud and increasing revenue. Using sophisticated RCM software enables healthcare providers to bill their services and collect payments accurately.

Healthcare Revenue Cycle Management Software

Proper revenue cycle management can improve clinical, financial, and operational efficiency and outcomes. You need solutions fine-tuned for your clinic/practice. Using software reduces the effort of managing revenue cycles. RCM software also prevents human errors and automates the process from pre-registration to payment.

When looking for healthcare revenue cycle management software, stick to platforms developed by RCM experts. Ask your RCM company if they cover businesses your size. Your team may also need a few sessions with the RCM software expert to learn how to leverage the technology. Working with experienced RCM companies can help you improve patient services, increase profit, and resolve unpaid claims.


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