Every visit creates a trail: a scheduled appointment, an insurance check, a record of what was done, a claim, a payment and sometimes a bill for the patient. Revenue cycle management is the work of managing that whole trail so the practice is paid correctly and on time.
The stages, in plain terms
Before the visit: collect insurance details, confirm coverage and get any approvals the payer requires. During and after the visit: the provider documents the care and a coder turns that documentation into billing codes. Claim stage: the claim is checked for errors and sent to the payer. Payment stage: payments are posted, denials are worked and unpaid claims are followed up. Patient stage: any remaining balance is billed to the patient.
Where the cycle usually breaks
- Front end: wrong insurance information or missing authorization.
- Coding: codes that do not match the documentation, or missing modifiers.
- Submission: claims sent late or with errors.
- Denials: rejected claims that nobody reworks.
- Follow-up: unpaid claims that age out unnoticed.
How to tell if your revenue cycle is healthy
A handful of numbers tell most of the story: days in accounts receivable, the percentage of A/R over 90 days, clean claim rate, denial rate and net collection rate. We cover each one, with common targets, in 7 revenue cycle KPIs every practice should track.
Do it yourself or get help?
Some practices run the entire cycle in house. Others outsource all or part of it. Our revenue cycle management service covers every stage, and you can compare options in outsourced vs in-house billing.
Frequently Asked Questions
Is revenue cycle management the same as medical billing?
Not quite. Medical billing is the claims and payment portion. Revenue cycle management also includes eligibility, authorization, coding, denials, patient billing and reporting.
What is the first step of the revenue cycle?
Registration and eligibility verification, before the patient is seen.
Want help with your billing?
Get a free review of your collections, denials and A/R.