Revenue Cycle Management Directory » Concepts

Revenue cycle management (RCM) is the process that manages claims processing, payment and revenue generation. It entails using technology to keep track of the claims process at every point of its life, so the healthcare provider doing the billing can follow the process and address any issues, allowing for a steady stream of revenue.

The process includes keeping track of claims in the system, making sure payments are collected and addressing denied claims, which can cause up to 90 percent of missed revenue opportunity.

RCM encompasses everything from determining patient insurance eligibility and collecting co-pays to properly coding claims using ICD-10. Time management and efficiency play large elements in RCM, and a physician’s or hospital’s choice of an EMR can be largely centered around how their RCM is implemented.