Revenue Cycle Management (RCM) in healthcare is the process of tracking and managing the revenue from patient services, from the initial patient interaction to the final payment. It encompasses all stages of the billing and collection process, ensuring accurate and timely reimbursement for services rendered.
Here’s a more detailed breakdown:
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- Patient Registration: This includes obtaining patient information, verifying insurance, and establishing financial responsibility.
- Insurance Verification and Claim Submission: RCM involves verifying patient eligibility with insurance providers and submitting claims for services
- Billing and Coding: Accurate medical billing and coding are crucial for proper reimbursement.
- Collection and Payment: RCM includes collecting payments from patients and insurance companies.
- Denial Management: RCM also involves addressing and resolving denied claims.
- Patient Registration: This includes obtaining patient information, verifying insurance, and establishing financial responsibility.
In essence, RCM aims to optimize the financial aspects of healthcare operations by ensuring accurate billing, timely payments, and efficient collections. It’s a critical process for healthcare providers to remain financially healthy and sustainable.