Revenue cycle management, or RCM, encompasses all financial processes involved in patient care, from scheduling to final payment. Understanding RCM helps clinic staff support financial stability.
The revenue cycle begins with patient registration and insurance verification. Accurate information ensures clean claims later.
Clinical documentation follows. Providers record services, diagnoses, and procedures. Documentation quality directly affects coding and billing.
Coding translates documentation into standardized codes. Accurate coding supports appropriate reimbursement.
Claims submission sends billing information to payers. Timely submission prevents delays.
Adjudication occurs when payers review claims and determine payment. Denials or adjustments may occur.
Payment posting records reimbursements and patient responsibility. Accurate posting supports account reconciliation.
Patient billing follows insurance processing. Clear statements improve collections.
Denial management closes the loop. Addressing denied claims recovers revenue.
RCM requires coordination across departments. Errors at any stage disrupt cash flow.
Understanding RCM helps staff see how their actions affect revenue. When clinics manage the revenue cycle effectively, they support sustainability and quality care delivery.
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