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What is Revenue Cycle Management in Healthcare?

Apr 9, 2024 10:59:48 AM / by Altruis


Taking control of your revenue cycle could be the best thing you ever do for your healthcare practice. With the right revenue cycle management strategies in place, a health clinic can become more profitable while maintaining its focus on patient care.

This article defines billing and revenue cycle management and outlines the best practices for creating a healthier revenue cycle.

What is the Definition of Revenue Cycle Management?

Revenue cycle management (RCM) is a process of combining all revenue generation activities of a healthcare organization into a cohesive revenue-building strategy. It’s based on the revenue cycle, which follows healthcare dollars through the entire process from pre-verification to billing to third-party reimbursements. 

When a healthcare clinic works to improve its RCM, each stage in the process is reviewed for speed, accuracy, and effectiveness in contributing to revenue generation. Roadblocks to healthy revenue are identified and removed.

Many federally qualified health centers (FQHCs) choose to partner with outside companies to improve their RCM. An FQHC is typically a busy, community-focused healthcare organization with a large number of Medicaid and Medicare patients. By selecting an outside partner to focus on RCM, the FQHC can lift an administrative burden from its associates while supporting consistent patient care.

Best Practices for Billing and Revenue Cycle Management

RCM is about more than just managing revenue on a day-to-day basis. The most effective RCM goes much deeper, creating a thoughtful and proactive strategy using revenue cycle optimization techniques.

Altruis helps healthcare clinics refine their revenue cycles using the best practices in modern RCM. Here are our tips for improving your revenue management.

Allocate Resources to Focus on Revenue

Start by examining your resource allocation and determining whether a lack of resources is hampering your ability to conduct RCM efficiently. Your in-house team may need more training or hours to handle billing, coding, and other processes related to RCM. Alternatively, you may need to work with an outside RCM partner to handle certain aspects of your billing and revenue cycle.

Hold a Kickoff Meeting

At Altruis, we’ve found that our clients are often determined to make a positive impact on RCM as quickly as possible. If this is a concern, hold a quick kick-off meeting with your associates and your RCM partner to build buy-in and get the process moving.

Walk Through Every Existing Process

Examine your existing processes, going through each stage step-by-step. Envision positive changes and identify skill gaps and resources needed to accomplish better revenue generation. Balance your patients’ needs with the practice’s need to stay strong financially.

Implement Paperless Procedures

As the world becomes more digital, so does the RCM process. Third-party payment sources like Medicare are becoming increasingly digitized in the movement to electronic health records. Check every step in your billing and reimbursement procedures for potential digitization, making it easier to monitor the process and move faster in your daily activities.

Improve Credentialing and Pre-verification

For many FQHCs, RCM needs improvement at the earliest stages of the process. For example, physician credentialing should occur as early as possible, before patients are seen in your clinic. Patient coverage eligibility should also be confirmed before services are rendered, which is an important factor in avoiding rejections and denials later when claims are submitted to third-party payment sources.

Claim Every Dollar

Ensure your clinic is collecting every possible dollar for covered services. Medicare pays at higher rates when a patient is new to an FQHC, reimbursing 34% more for Initial Preventive Physical Exams (IPPEs) or Annual Wellness Visits (AWVs). Are you sure your practice is submitting claims for the proper Medicare rates?

Address Denials and Rejections Promptly

Health clinics reliably recover more revenue when they learn how to defeat denials and rejections from reimbursement sources. Analyze your pending claims and follow up on any rejected claims immediately. This not only shortens your revenue cycle but improves your odds of securing valuable reimbursements, day after day.

Claim Retroactive Revenue

After your services are provided, some patients will become eligible for coverage. This is known as retroactive coverage and it can significantly boost your clinic’s revenue. 

Altruis uses a process called RetroPay™ to secure reimbursement for self-pay claims that may otherwise have been written off as bad debt. This is a win-win for patients and providers because patients observe no change in their services while providers claim increased revenue. It’s an excellent example of the revenue-focused approach we take as your RCM partner.

Altruis: Your Revenue Cycle Management Partner in the Process

What is the definition of revenue cycle management in healthcare? Altruis.

Our goal is to help you implement the best billing and revenue cycle management practices so you can better serve your community. Try our fast and free billing assessment to determine if you’re missing out on valuable revenue. 

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Topics: Revenue Cycle Management


Written by Altruis

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