What is revenue cycle management?
Revenue cycle management is the process of identifying, managing and collecting the money a practice earns for patient services. It starts before the visit and ends only when the claim and the patient balance are paid. A gap anywhere along the way, such as a missed eligibility check or a coding error, costs money later.
The steps in the revenue cycle
- Registration and eligibility. Collect accurate patient and insurance details and verify coverage before the visit.
- Prior authorization. Get approval from the payer when the service requires it. See prior authorization.
- Charge capture and coding. Turn documentation into accurate CPT, ICD-10-CM and HCPCS codes with medical coding.
- Claim submission. Scrub and submit claims electronically, inside payer filing deadlines.
- Payment posting. Post insurance and patient payments and reconcile them against what was billed.
- Denial management. Work every rejection and denial and fix the cause. See denial management.
- A/R follow-up. Chase unpaid claims by age and dollar value. See accounts receivable follow-up.
- Patient billing. Send clear statements and follow up on balances with patient billing.
- Reporting. Track the numbers that show how healthy the cycle is, such as days in A/R, clean claim rate and denial rate.
Why practices outsource RCM
Running the cycle in house means hiring, training and managing staff who need to keep up with changing payer rules and code sets. Outsourcing gives you a team that does this every day. Read our comparison of outsourced and in-house billing to weigh the options.
How we work with you
We start with a free review of your collections, denials and A/R, then take over the steps you want to hand off, whether that is the full cycle or just a few pieces. You pay a percentage of what we collect, with no upfront fees. See how medical billing pricing works.
Frequently Asked Questions
What is the difference between medical billing and revenue cycle management?
Medical billing is the claim and payment portion of the process. Revenue cycle management is broader and includes eligibility, authorization, coding, denials, patient billing and reporting.
Can I outsource only part of my revenue cycle?
Yes. Many practices hand off claims and follow-up first, or only denial management, and add other steps later.
How long does it take to get started?
Setup depends on your systems and payers. We handle the transition so your billing continues without a gap.
Want help with your billing?
Get a free review of your collections, denials and A/R.