Revenue Cycle Management

RCM is the lifeline of any physician practice.

What is Revenue Cycle Management?

Revenue Cycle Management (RCM) is the lifeline of any physician practice. Most healthcare professionals make a mistake of finding it equivalent to their practice medical billing company. RCM is a lot more than billing. It is a process that includes claim processing and denial management, patient payments, coding and billing, and revenue generation.

The increased revenue stream depends on time management and the practice workflow that begins at time of registration where patient insurance eligibility is determined and co-pays are collected, and end with correct coding of claims using ICD-10 and sending them out on time.
An efficient billing system is also an important benchmark of a successful RCM. This can be achieved by implementing the right EHR and Practice Management system or outsourcing the practice’s RCM to a reliable vendor.

Practice RCM Workflow

• Patient scheduling and eligibility verification

The revenue cycle begins the moment patient calls to schedule an appointment. The front-desk staff should be equally skilled in dealing with the new and returning patient. In case there is a new patient, it is necessary to collect and verify patient insurance and demographic details accurately. Get those wrong and your claims will be rejected right away. For a returning patient, ask for any change in details and remind them of their past non-payments.

• Patient visit and clinical documentation

Patients’ clinical documentation should be complete and according to the requirements of CMS guidelines. Assimilate the documentation process into daily decision making to ensure that the patient record is complete and compliant with ICD-10 coding standards.

• Superbill completed by provider

This is the most critical phase of the RCM workflow. Based on the information in the Superbill, the physician will be paid for the services provided. The Superbill should contain the diagnosis and procedures performed on the patient, along with correct CPT and ICD codes.

• Patient payment and copays obtained

Collecting copays at the time of registration is usually the best front office practice. However, in case of patient emergency or peak hour rush, patients can be asked to pay before they leave the practice.

• Coding and billing

Physicians should have CMS certified EHR and Practice Management system that would enable them to code with ICD-10. Due to the complex nature of the codes, practices should hire professional coders to ensure claim processing on the first submission.

Creating an accurate claim is the most crucial phase of the workflow. The revenue of a practice depends on the acceptance of claims submitted. It is important that the claims have accurate details and is submitted on time.

• Claim processing

In this day and age, claim denial is a serious concern that providers have to face. Delayed reimbursements due to claim denials weigh heavily on the revenue stream of the practice. To avoid the delay, it is imperative that the providers, front desk, coders and billers, and clinical staff should provide accurate details, which are required to be mentioned in the claim.

• Payment received

The RCM completes when the providers receive payment for their services. In case of denied claims, the provider will be informed through ERAs. Then begins the cycle of claims processing, consuming your time and resources.

Manage your RCM workflow with technology

Under the HITECH Act, providers implemented certified EHR and Practice Management systems at their practices, which resulted in the automation of their RCM. Technology has increased the efficiency of practice workflow and improved patient care. Advanced automation of the solutions enables providers, front desk and clinical staff, and coders and billers to save time and increase performance level.

  • Automate patient’s insurance eligibility and benefits in real-time with a single click
  • Automate patients’ responsibilities from the system
  • Automate coding and claim preparations

Limitations: In-house management of practice revenue does not end with a perfect EHR software and PM solution. There should be expert coders and billers who can provide you with optimal results, by making use of the available technology. According to AHIMA, it will require 16 hours on average to train your staff in ICD-10-CM, 24 hours on ICD-10-PCS and 10 hours on practice implementations. Moreover, a professional code can cost you around $50,000 per annum.

ICD-10: A hurdle in successful RCM path

With ICD-10 on the horizon, it is smart to not take any chances with your practice’s RCM. This is the most significant change in the healthcare industry since 1979. It is expected to affect every domain of the practice – particularly the revenue cycle. The drastic increase from 17,000 to 140,000 codes is bound to impact clinical and billing systems of a practice. To manage this change, physicians, coders, and billers will require greater understanding and comprehension of ICD-10 codes to save their practice from huge losses.

CMS has estimated the loss that practices may incur if their billing is not prepared for the challenges ICD-10 will bring:

  • Claim errors will increase by 7%
  • 40% increase in A/R days
  • 200% increase in claim denial rates

These numbers are relevant to a healthy practice with a relatively sound revenue stream.

Make the smart move: Outsource your practice RCM

Though ICD-10 will affect hospitals and practices of all sizes, small and medium practices in particular would find it difficult to cope with the revenue loss. In 2014, AMA carried out a research to identify the estimated cost of ICD-10 implementation for practices.

  • Small practice $56,639-$226,105
  • Medium practice $213,364-$824,735
  • Large practice $2,017,151-$8,018,364

This is why it is crucial for the practices to outsource their medical billing to an experienced and reliable RCM partner. Black Book Rankings Survey 2014 indicates that practices that have outsourced their medical billing have reported 6% increase in their revenue; while 90% of solo and small practices are considering outsourcing their RCM before ICD-10 deadline.

CureMD Revenue Cycle Management Solution

CureMD offers its customers complete end-to-end RCM solution. We understand your RCM needs. Our teams of certified coding and billing professionals work tirelessly to boost your reimbursements and streamline your revenue workflows. We ensure:

  • 96% claims will be paid on first submission
  • 16 days average Medicare turnaround
  • 24-hour access to your financial reports
  • Over $34,000 in annual savings

RCM services: Our RCM solution is unmatched in the industry. We offer:

  • Fee Schedule Review and Analysis
  • Eligibility and Benefit Verification
  • Assistance with Provider Enrollment
  • Electronic and Paper Claims Submission
  • Account Receivables Management
  • Secondary Insurance Billing
  • Incoming patient calls
  • Old Account Receivables Recovery
  • Authorization Request and Tracking
  • Charge Entry – All Specialties
  • Posting of Insurance and Patient Payments
  • Extensive Insurance Follow Up
  • Patient Statement Processing and Mailing
  • Denial Review and Management
  • Appeal of all Denied or Low Paid Claims
  • Management reports




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