RCM Revenue Cycle Management
Healthcare revenue cycle management is a
financial process that medical professionals
utilize to manage their administrative and
clinical functions related to claims processing,
payment and revenue generation. This process
incorporates the management, identification
and collection of patient services revenue.
“If you’re bringing in a certain amount of revenue, you can’t have
expenses that exceed that revenue. It seems very basic but people don’t
look at it that way.”
Pre Claim:
This involves the creation and management of patient files, contract
negotiation, and verify patient enrollment.
Everything that occurs before and immediately after the appointment of the
patient. This comprises scheduling and eligibility verification through treatment
and payment arrangement.
Submitting the claim to the insurance service provider by using any mode
like email, cash or electronically.
Everything that occurs before and immediately after the appointment of the
patient. This comprises scheduling and eligibility verification through
treatment and payment arrangement.
With this RCM process, other tasks like
reporting and analysis, compliance, and
quality management are frequently being
"Global Healthcare Revenue Cycle
Management Market is predicted to grow at a
healthy CAGR of 12.2% during the forecast
period and is estimated to reach USD 43,500.0
million by 2027."
RCM is a significant part of the
Healthcare Industry
Healthcare organizations need to have
policies & practices in place for
remaining financially stable. This is where
revenue cycle management come into play
allowing healthcare professionals to operate
foolproof on a regular basis
"As per the survey conducted by Black Book Research,
92 % of hospital CFOs relocated their strategic focus to
revenue cycle management technology and vendor
selection, last year in response to decreasing
healthcare reimbursements."
Benefits of RCM
• Allow you to improve patients care by simplifying the
billing & collection cycle.
• With RCM, communicating with EHR & accounting
system becomes easier.
• Bridge the gap between business and clinical sides of
• It makes all the information available that helps to
avoid revision or resubmission of claims.
• Helpful in analyzing the revenue goals.
• Helpful to identify the loopholes by generating reports
correspondent to billing data.
Challenges RCM is
Facing Today
Every clinic face challenges so to overcome them it is required
to tackle with the latest approach.
The old concept of billing and coding is changing and tending to move towards
automation. As it becomes the obvious condition because some of the specific
gaps or mistakes in revenue cycle can negatively impact the profit driving
activities like:
• Claim Submission
• Outstanding Accounts Receivable
• Failure to review EOBS for denials
• Registration and Verification
"Fifteen cents of every US health care dollar is spent towards revenue cycle inefficiencies."
Processes are becoming more automated and complex. Thus,the evolution came
up with a number of challenges for every medical practice so, the practitioners need
to consider:
Maximize Performance:
Declining reimbursement and rising costs mean practice need to capture every
earned dollar.
Minimize cost:
Payment per claim is flat if not declining, and RCM costs are only increasing.
More complicated than ever and with higher stakes.
Business Intelligence:
Increasing the need for sophisticated data to drive business.
RCM platforms rely on an expanding ecosystem of technologies that
have the function in tandem.
Migration to Value-Based Reimbursement:
New RCM processes are different from Free-For-Service.
Direct patient payment:
With the increasing costs of health insurance, this is the large source of
Staff recruitment and relation:
It’s harder to find and keep talents.
It is very much imperative for
any system to understand
that the key factor for
outsourcing is not only the
technology used but the
personnel who coordinate
and control the software and
system. The process is too
complicated that can’t be
relied fully on technology but
gives the privilege to staff to
devote more time on highvalue tasks by automating the
non-core activities.
"The amount, $ 2.7 trillion has been spend annually on healthcare industry by the country,
of which $ 400 billion is spent on claims processing, RCM, billing, and bad debts."
Key RCM Elements to Measure
Revenue Cycle Transformation:
End-to-end people, processes, and technology can be optimized
to accelerate cash, automate processes and improve operating
Rapid Response:
Rapid assessment and implementation helps
to build a roadmap for a long-term
Referral Management and Patient Access:
Reduce patient leakage, secure coverage, improve
pre-service collection and prevent denials and
Revenue Integrity:
Improve charge capture, revenue
reconciliation, and clinical
Operational Consolidation:
Create or refine shared services to
reduce cost and enhance the patient
financial experience.
EHR Optimization and Conversion Readiness:
Optimize existing EHR architecture and evaluate
conversion plans to reduce costs, increase
revenue and limit go-live disruptions.
Why should
you Outsource
your RCM?
It’s a culture change not just a change in the process
When RCM was a simpler process it was led by only smaller teams with
specialized skills. Owners relied upon the individual skills, the perceived
“best” practice was having a strong biller who could find profit within the
billing cycle.
As businesses developed the complexity also raised, this work culture
proved to be inconsistent. The industry recognized that outsourcing this
work can help in making cycle seamless and more profitable.
• Claims processing shifted from a human activity to a technology-driven process
assisted by humans.
• Technology requires capital, whereas an outsourcing firm that already have
various tools as they have many clients.
• Technology requires integration and management, and an outsourcer can hire
the right talent to manage it efficiently.
• Repeated process leveraged by technology can drive more profit for businesses
Find the right revenue management service partner who
can help you with:
• Saving your time,
• Improving cash flow,
• Remaining compliant and
• Improving staff satisfaction
Collaborate with Cogneesol
Insight-driven healthcare data is the foundation of effective,
efficient and affordable healthcare services. That’s why most
of the leading names choose Cogneesol, by considering our
proficiency in handling healthcare revenue cycle services.
It becomes highly vital that you should have an better revenue cycle
management process. How do we help you?
• Enhance cash flow
• Streamline operations
• Quick revenue insights
• Continuous monitoring of crucial revenue cycles
Our Revenue Cycle Management encompasses
• Admission and registration with insurance
• Patient admission/registration and patient visit
• Clinical documentation
• Medical coding, patient health information entry,
and management
• Medical billing
• Patient’s accounts management
Get In Touch
United States of America
Phone: +1 646 688 2821
United Kingdom
Phone: +44 203 371 7486
Phone: +1 905 487 8562
Phone: +61 286 078 983
Email:[email protected]