What Is Healthcare Revenue Cycle Management?

A healthcare revenue cycle management system (RCM) is a financial procedure that makes use of billing software to track each step of the patient care system from registration to the payment of the last dollar. It works ideally with a doctor appointment reminder system to help the administrative staff keep track of the movement of patients in and out of the clinic.  

For a medical practice to be declared successful, we not only have to consider the quality of service offered but also the financial bit. A health provider or clinic must be able to execute efficient and accurate billing processes to either the patient or their insurer. And this is where a revenue cycle management system comes into play.

As stated earlier, RCM is a process that finally translates into revenue for the medical organization. For this to happen, personal data from the patient must be captured (together with the insurer’s), codes must be generated. This implies that the organization must have a coding and billing system that is centralized.

It is quite the process. If you have a medical practice seeking to implement an RCM, keep reading on.

The steps of a Revenue Cycle Management System


Capture is the first process of the RCM process. Information on the patient is entered into the system for billing purposes. Information on the clients will also clearly set out the charges as per the medical procedure.


The medical practice should ensure that the medical codes used are compliant with state and federal rules. You might want to engage a coding specialist to guarantee you use accepted medical codes. These same codes will be used by the insurers.

Submission of claims 

For the clients covered with insurance companies, healthcare providers will send claims, requesting payments. Be sure that the insurers will check your claim against the set rate. An accurate claim will prevent back and forth between you and the insurer.


It is recommended that you have a billing manager. He or she will handle the regular (and sometimes, terse) communication with the insurers. Your billing manager will ensure there are no errors and certainly no denials with regards to the reimbursements.

Collection of payments 

In the case of any outstanding balances after receipt of insurance reimbursements, the practice should follow it up with the patient.

The hindrances

The RCM has challenges just like any other system on the face of the earth. Accuracy is one of the biggest challenges in the RCM system. Patient information, billing, and coding must be done accurately for the claims to be submitted to the client. Otherwise, in the case of inaccurate information, you are bound to have some back and forth with the insurers.

Payment collection is also proving to be an increasing issue. More and more patients are deciding to shoulder the burden when it comes to payments. Due to the high costs at times, patients are unable to cover the whole cost.

Leave a Comment

Required fields are marked *.