The full form of RCM is Revenue Cycle Management. RCM is the financial procedure used by healthcare institutions to track patient care episodes. It consists of everything from registration and appointment scheduling to the final payment of a balance using medical billing software.
RCM connects administrative and clinical data, such as an insurance provider, patient’s identity, and other personal information, with the treatment a patient receives and their healthcare data.
Communication with health insurance companies is an important aspect of RCM. When a patient makes an appointment, the physician’s office or hospital personnel usually double-checks the patient’s claimed insurance coverage before the visit. A healthcare practitioner or coder categorizes the nature of the therapy using ICD-10 codes when an insured patient receives treatment for a specific ailment and pays any applicable copayment. The hospital or care facility then sends the care summary with ICD and Current Procedural Technology codes to the patient’s insurance company to determine what percentage of the care will be covered by insurance and the patient will be billed for the balance.
According to the Healthcare Financial Management Association (HFMA), the revenue cycle encompasses all administrative and clinical operations that contribute to the capture, management, and collection of patient service revenue.
The revenue cycle involves the following steps:
- Charge capture: Medical services are converted into chargeable expenses.
- Claim submission: Submit billable fee claims to insurance carriers.
- Coding: Diagnoses and procedures must be coded correctly.
- Patient collections: Calculating and collecting patient balances.
- Preregistration: Before a patient arrives for inpatient or outpatient services, gather preregistration information such as insurance coverage.
- Registration: Following patient information is collected during registration in order to establish a medical record number and meet numerous regulatory, financial, and clinical criteria.
- Remittance processing: Using remittance processing to apply or reject payments.
- Third-party follow-up: Getting money from third-party insurance.
- Utilization review: Examining the importance of medical services.
Also Read: What is the Full Form of FCI?
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