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Steps of Revenue Cycle Management

Steps of Revenue Cycle Management
Here are the steps of revenue cycle management.

The revenue cycle plays a heavy role in how successful healthcare organizations become. If you do not have a strong billing department, your practice could be missing out on a great deal of money from patient payments and payer reimbursements, among other things. Understanding and performing superb revenue cycle management is necessary if your organization is going to succeed. Here are the steps of revenue cycle management.

Pre-Authorization and Eligibility Verification

During this step, you look to gather insurance and financial data from your patient. You can benefit from using automated eligibility verification devices because you will figure out how you get paid for varying services. The patient benefits as well because they will understand their financial obligations right away.

Services and Charge Capture

After services get provided to patients, the next step of the revenue cycle management process is to have all services that were offered transcribed into billable charges. This is done through a process known as charge capture. This step is critical because it’s the moment when a medical billing code gets assigned to the claim. If you have sufficient medical billing software, your staff will be able to use coding tools that will allow everyone to code with more precision. This helps to ensure reimbursement is delivered in a timely manner. With claims scrubbing technology, your claims will be coded more accurately. As a result, you will save a lot of money in administrative expenses and claim re-work.

Claim Submission and Denial Management

Next, you need to submit a claim. After the charge capture process, you need to submit a claim to the payer that is coded correctly. Practice management software can make this step more efficient because you can track your claims at any time of day in real-time. This helps you stop claims before they can be denied, and it ensures that you submit the greatest number of clean claims that you can.


After your patient’s insurance reviews your claim, the cost gets posted, and the patient should be getting ready to pay. If you have an integrated billing solution, patients will have the ability to look at their bills and pay them within their patient portal. You can also have your solution remind patients about when they need to make payments and encourage them to make those payments. Because of this, you will likely get more payments received punctually, and they are more likely to be paid in-full. This step also does best with quality collections services that come from your revenue cycle management vendor.

Quality Reporting

Receiving payment from the patient can be viewed as the last step of revenue cycle management. However, it is best for your practice to have sufficient reporting technology because it will help you to stay on the right path and prevent you from making costly errors. It becomes easier for your practice to find common problems in your revenue cycle management process that stop your practice from bringing in as much revenue as it could. It helps to have the right vendor or software because they can help you figure out what trends are causing you to lose money.

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This entry was posted on Thursday, October 8th, 2020 at 10:22 am. Both comments and pings are currently closed.