What is Healthcare Revenue Cycle Management?

January 20, 2022 by Antonio Arias, MBA, CHBME

Topics: Revenue Cycle Management, Practice Management, Medical Billing Company

The primary function of every medical practice is to provide quality care to its patients. However, every healthcare organization also has a critical secondary function—staying financially healthy. If you’re considering outsourcing your healthcare revenue cycle management, then it’s important to educate yourself on the different types of services that are available and how they could apply to your practice to satisfy your financial needs.

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What Is Healthcare Revenue Cycle Management (RCM)?

Healthcare revenue cycle management entails the administrative and clinical components of operating a medical practice. Everything associated with attracting new patients, delivering quality care to patients, billing insurance, processing claims, and more are all part of the revenue cycle. Since revenue cycle management encompasses so many elements, this is a crucial facet of running a successful medical practice—if your revenue cycle isn’t being properly or efficiently managed, your practice could be suffering.

The healthcare revenue cycle begins when a patient schedules an appointment to see a provider at your medical practice and ends when payment has been collected for that interaction; however, this doesn’t wholly cover the lifetime value of a patient.

The steps in the revenue management cycle are as follows:

1. Insurance Verification

When a patient schedules an appointment with your medical practice, your administrative staff establishes the patient account by collecting basic demographic information and verifying their insurance. Insurance verification is a critical step to making your healthcare revenue cycle more efficient since incorrect insurance information can lead to delayed payments, wasted time, and a headache.

2. Medical Coding & Billing

After a patient has been seen, your medical practice has to translate the treatment received into appropriate and accurate medical codes in order to submit a claim for reimbursement from the private or government payer. Accurate medical billing and coding is essential to keep the healthcare revenue cycle streamlined and effective; just as with inaccurate insurance information, miskeyed medical codes can greatly hinder payment, take up extra time, and cause a headache.

3. Follow Up

The claims processing cycle involves more than just accurate coding; the staff at your medical practice also has to monitor the status of the claim, address any issues the insurance company might have, and more. Claims can be denied for various reasons including inaccurate coding, missing information, incomplete patient records, and more. Anything not covered by the insurance company is then sent over the patient to collect any remaining balances. Sometimes the entire healthcare revenue cycle can last for weeks, months, or years depending on the situation. 

Of course, the entire goal of effective revenue cycle management is for your medical practice to efficiently complete each step of the cycle as quickly and accurately as possible in order to receive prompt payment and reimbursement

healthcare revenue cycle management is a team effort

Who Benefits from Healthcare Revenue Cycle Management?

Pretty much anyone involved in the medical practice experience—the patient, your practice itself, and the payer—benefit from effective healthcare revenue cycle management. Ensuring that every part of the process is complete and accurate results in a smooth, streamlined process from start to finish.

Properly managing claim denials and developing procedures to address any errors that might have occurred along the way is a great step towards optimizing your revenue cycle management strategy. However, depending on which part of the process that your medical practice struggles with the most, outsourcing your healthcare revenue cycle management might be the best method moving forward!

5 Types of Healthcare Revenue Cycle Management Services

Let’s break down 5 types of healthcare revenue cycle management services that NCG Medical can provide to your medical practice:

1. Medical Billing

When considering outsourcing for your practice’s medical billing, it’s important to find a company that will customize the experience to suit its unique needs. Medical billing is a service that can be useful for revenue management of:

  • Hospitals
  • Surgery Centers
  • Radiation Oncology Cancer Centers
  • Urology Practices
  • Family Medicine Offices
  • Orthopedic Practices
  • Internal Medicine Offices

For more information about billing services with NCG Medical, visit our medical insurance billing page today.

2. Dermatology Billing

For dermatology revenue management, having certified medical coders, MBAs, and CPAs as trusted consultants can be an invaluable advantage over competing practices. Benefits they can offer may include:

  • Streamlined automation workflows geared toward dermatology
  • Customized strategies for growth, tailored to your dermatology practice's unique needs
  • Extensive knowledge in practice management software

Find out what dermatology billing services NCG Medical can offer your practice.

3. Gastroenterology Billing

When it comes to gastroenterology revenue management, partnering with expert consultants can certainly come in handy. Innovative software and strategies made specifically for gastroenterology practices can dramatically improve the way healthcare revenue management services are delivered.

Learn more about the gastroenterology billing services offered at NCG Medical today.

4. Radiation Oncology Billing

Your radiation oncology practice needs a medical billing system that works for you. With specialized healthcare revenue cycle management services, you can get paid faster and easier, and with much fewer headaches. By utilizing NCG Medical for your radiation oncology billing needs, you’ll have access to your practice’s medical billing at any time, any place with mobile compatibility.

5. Holistic Billing Services

Medical billing services extend far beyond dermatology, gastroenterology, and radiation oncology. At NCG Medical, we also have experienced providers in holistic billing solutions for acupuncture, chiropractic, and massage practices.

For more information about our holistic billing services, contact us today.

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