Revenue cycle management is one of the most critical processes that organizations need to master to be successful. Here’s what you need to know!

Understanding healthcare revenue cycle management is crucial for every healthcare organization, large or small. In this article we’ll take a look at the basics of healthcare revenue cycle management and its impact on the healthcare industry.



For those who don’t know, revenue cycle management is the financial process that is used to manage administrative and clinical functions associated with claims processing, payment, and revenue generation. The process includes the identification, management, and collection of patient service revenue. This financial process is imperative to keeping healthcare organizations operating in order to treat patients. Essentially, it’s how the bills get paid!

Revenue cycle management begins when the patient makes their appointment to seek medical services, and ends when all claims and payments have been collected. Between the patient and the final collection, the process includes claims submission, and then sent out to the payer for reimbursement. The goal of healthcare revenue cycle management is to develop a process that helps organizations get paid the full amount for services as quickly as possible. That’s what makes it unique.



Simply put, healthcare organizations must stay in the black and maintain profitability to be successful at healthcare revenue cycle management. Managing claims denials is the most effective way to do this. A great deal of errors can occur in the beginning stages of a patient’s account, which can carry on throughout the revenue cycle, disrupting claims reimbursement. It is particularly important to verify the patient’s insurance eligibility during pre-registration in order to be sure that insurance providers will reimburse the healthcare organization for any provided services.

Organizations should also seek to manage claim denials and have procedures in place for quickly handling any reimbursement issues. Anything from improper ICD-10 coding to a missing signature on a chart can cause a claim to be denied. Many claims denials are avoidable so long as staff are properly trained to use billing forms and in counseling the patient about medical costs. Revenue cycle software can also help automate processes like insurance verification and coding. Organizations should also track claims and investigate the causes of denials to help prevent them from occurring in the future. Using analytics software and services like health IT solutions is also recommended for successful healthcare revenue cycle management.



Healthcare regulations and reimbursement models are constantly changing and being updated, which can make it difficult for healthcare organizations to maintain their healthcare revenue cycle management policies. One of the main challenges for healthcare organizations is collecting payments from patients at or before the point-of-service. Many providers day that it can be daunting to try and collect payment from patients before they leave the office. This is further complicated by the fact that many patients cannot afford to pay medical bills upfront. It can be a real challenge to ensure debts are collected without pressuring patients to the point of pushing them to seek care elsewhere.

Another challenge to maintaining revenue cycle management is tracking a claim through its lifecycle from start to finish. As tough as it may be, professionals should monitor claims processes closely in order to ascertain where any errors are being made. It goes without saying that revenue could be lost if providers can’t identify where issues originated, and solve them with haste.

In conclusion, many of these challenges can be mitigated or avoided if healthcare organizations educate and train their staff, and take advantage of technologies available to providers to help maintain an efficient revenue cycle management policy.