Understand What Revenue Cycle Management Stands For
Revenue Cycle Management or RCM is a financial process that starts the moment a patient schedules a medical appointment and ends when the billing of medical services from the payer (insurance company) is completed. RCM uses special software for medical billing and collection that facilitates the entire process.
As said previously, the process begins when the physician examines the patient and specifies the diagnosis and procedure codes which are then forwarded to the payer. Every insurance company has their medical claims examiners who approve or deny the claims upon evaluation. There are a few elements that decide whether the claim will be accepted or declined, such as the eligibility of a patient, the credentials of the medical provider, and medical necessity.
If the claim has been denied by the insurance company, the medical provider makes corrections and sends it back. The whole process ends once the insurer pays the medical bills of a patient or a provider accepts the compensation offered.
In recent years, the industry has seen an increase in medical providers choosing a Revenue Cycle Management company to partner with to lessen the administration burden. In that way, healthcare providers increase their efficiency and the ability to offer better medical services to patients in need.