Process

REVENUE CYCLE MANAGEMENT (RCM)
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  • Process

Revenue Cycle Management

Patient-Centric Revenue Cycle includes steps starting from patient account creation through closing the account with a zero balance.
The three broad phases are Pre-Service, Time-of-Service, and Post-Service.

The Healthcare Financial Management Association (HFMA) defines a revenue cycle as

“All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.”

medical billing software

RCM STEPS

Pre-Service Steps
  • Scheduling
  • Pre-registration
  • Insurance Verification
  • Pre-Certification
  • Price Estimation
  • Financial Counseling
  • Cashiering
Time-Of-Service Steps
  • Patient Arrival
  • Validation and Activation
  • Financial Clearing
  • Patient Care Delivery
  • Clinical Documentation and Revenue Recognition
  • Case Management
Post-Service Steps
  • Claim Processing
  • Remittance Processing
  • Denial Processing
  • Payer Payment Analysis
  • Third-Party Followup
  • Customer Service
  • Self Pay Collections
  • Collection Agency