What is a Revenue Cycle Management Company? Everything to Know

Have you ever wondered how health care providers manage their finances?

Or perhaps, you run one and are looking for an effective solution to the complicated system of revenue management.

Whichever you are, you probably know that health care providers are constantly chided for their high-cost services towards patient treatment. But as noble and unprofitable as some might expect these services to be, the truth is, hospitals and clinics are unable to function efficiently without maintaining a healthy financial system.

And so, in order to keep things productive, they incorporate a system of revenue cycle management (or, RCM).

So, what is RCM and what purpose does it serve?

Let’s find out.

Revenue Cycle Management: A Definition

It is a process through which health care providers are able to track a patient’s payments or revenue cycles from their initial appointments, right up to their final payment.

To do this, a hospital may employ a revenue cycle management company that has expertise in practicing this very process. These companies generally follow very specific steps to track a patient’s payments before their initial visit, during their visit, and after their visit.

So, what does an RCM company’s process look like?

The Pre-Visit Process

Beginning a patient’s revenue tracking before their initial visit might seem redundant, but it is actually very essential. It is where the whole process begins, and only with pre-visit tracking can there be a wholesome analysis at the end.

This part of the process mainly involves:

  • Demographic Verification: For new patients, it involves getting accurate details about their current address. In the case of old or returning patients, it involves verifying their current whereabouts and documenting any changes in residence since the last visit.
  • Eligibility Check: This involves verifying whether the patient is eligible for insurance.

These initial communications help set the stage for a fruitful RCM process.

What Comes Next?

After the pre-visit formalities are complete, the companies have to obtain documentation from the health care provider. This is done to check whether the insurance companies are liable to fulfill the payment. This process looks something like this:

Obtaining and Verifying Clinical Documentation

During a patient’s treatment (or after the treatment), their clinical documents must be recorded and submitted. In order to be eligible for insurance payment, it must comply with the ICD-10 standards.

Once the documentation is analyzed, it will be determined what portion of treatment is payable by the insurance company, and what must be billed directly by the patient.

The Superbill Payment

This is the most important step in the medical billing process. After the verification is complete, the superbill must be paid off. The company ensures that the payment is completed and paid to the respective physician or health care provider.

Collection of Payments

The remainder of the patient’s payment is collected from the patient. It is now common practice to ask the patient to complete payment during registration itself.

Post-Visit Practices

Now, after payments are issued there are still some things that need taking care of. Claims need to be processed, seen through, and recorded.

Follow-Ups and Additional Claims

This is done when insurance companies fail to comply with all the specified payments. RCM companies will get in touch (via phone calls, emails, etc.) to remind and ensure that these payments are made. Inquiries will be made into failure to pay and investigated if necessary.

Verification of Receipts

Once the payments are complete, receipts must be verified to ensure that all parties have complied with their payments. This ensures that the process has been true to its purpose of collecting and remitting payments to the appropriate parties.

Data Analysis

Finally, to complete the process, all data will be compiled and analyzed to derive meaningful insights. These insights will then be used to understand how to make the system more efficient, effective and quicker.

This step is crucial to maintaining a stable financial system for health care providers, while allowing them more information relating to elements like performance, cost, etc.

Utilization Review

While examining data, the necessity of the medical services will also be reviewed. This enables a service vs cost analysis.

Why Do Providers Outsource RCM or Medical Billing?

So you might now wonder, why providers choose to outsource this process to a company. The truth is, it can be a complicated, time-consuming process that often requires external expertise. Some other perks include:

Improved Patient Care

It allows hospitals and clinics to do what they do best without the added hassle of revenue management. The exclusive focus on patient care makes for a more efficient system.

Less Room for Error

Since the whole process often calls for a different, more financial form of expertise, it lowers the chances of billing errors. A third-party company can often add fresh perspectives to analytics and insights that an insider might sometimes miss.


Whether it’s with regard to RCM technology or the cost of setting up an in-house system, a company is likely to be far more cost-effective in the long run. Also, the lower risk of errors is also a contributing factor to better finances.

Challenges Along the Way

The revenue cycle management process is not without its challenges. The intricate system of billing management, maintaining accurate charge descriptions and complying with coding requirements are very real issues that RCM companies face.

Even claim compliance can often be time-consuming and tedious when dealing with difficult insurance companies or patients. However, with the right company and the right technologies, your medical systems can take a step in the right direction.

Like this article? Check out our ‘insights’ category for more valuable perspectives on all things business.

Dodge The Issues That Cause A Young Company To Crash

StrategyDriven Managing Your Finances Article |Business Success|Dodge The Issues That Cause A Young Company To CrashDid you know that over ninety percent of businesses fail in their first year on the market? This shows you how risky setting up a company can be. It’s very much a lottery whether your company is a success and survives for the long term or even beyond the first couple of years. Why is this? Well, first, there’s the competition. Thousands of new businesses open each year and it makes sense that customers are not going to buy from them all. Instead, they are going to pick the ones that are providing the most appealing options or the best price. In some cases, it’s possible that the winner won’t have either of these factors on their side but will still come out on top. We’ll discuss why that might happen a little further down.

The good news is that once you open your business on the market, you can avoid most of the issues that cause it to fail. This can be related to financial decisions, marketing and promotion or the routes you take to build up your brand. Let’s get started and we’ll begin by exploring visibility.

Poor Visibility

If your business fails, then it could be because you have a poor level of visibility. Visibility is all about how easy it is for customers and potential customers to find your business online. This will depend on your marketing efforts and how successful your campaign has been. Some businesses have no trouble getting to page one of the SERPs for their targeted keywords. Others will struggle to get to page ten and most consumers won’t even get up to page two. The bottom line here is that if you don’t make the right choices with your promotion and marketing then you will be dead on the water.

Mistakes here can be both minor and complex. For instance, a minor mistake is thinking that marketing is one and done. It isn’t and you should be thinking about incorporating it into your monthly business budget. A more complex mistake is based on the type of campaign that you choose to run. Ultimately, you need to make sure that you are taking steps to run a targeted promotional campaign. Unless your business is already successful, you’re not going to be able to focus on every area of the market. You need to research your target audience, identify where they are online and build your marketing campaign around this. For instance, you don’t need to include every social media network if your target customers don’t use Facebook and Instagram.


It is possible that you are overspending in your business. If you end up in the red running your company, then you’re not going to last much longer on the market. You need to make sure that you are keeping your business books healthy. While a business can start with zero profitability and making a loss, this is never going to be a sustainable business model. Instead, you need to think about working to ensure that you are making money with your company. So, how do you avoid overspending?

Well, first, you need to make sure that you are aware of the issue. You can do this by hiring an accountant. An accountant will be able to keep a check on spending in your company and make sure that you are staying in the green. They can also help you keep your business model more efficient by telling you where you can afford to reduce spending as well as where you might need to increase it. A lot of business owners will avoid hiring an accountant in an effort to save money.

It’s certainly true to say that an accountant can be expensive, particularly if you take one on fulltime. However, you can save by outsourcing this solution to another business. That way you can cut the cost and still have an expert on the phone whenever you need their advice.

If you are not going to hire an accountant, then you at least want to make sure that you are using an online digital solution. The software can be used to track your spending, keep a check and manage the books. This is also useful when the tax man comes around.

Running Out Of Money

Of course, it is possible that you are making a profit but you’re also running out of money in your business model. This will usually be the case where the budget isn’t enough to sustain the high levels of demand. The instinct here will be to cut back and make sure that you keep costs down by limiting your business model. However, this will typically be a mistake. If you do this, then what you end up with is a business that is unable to grow and that remains stagnant. Customers will quickly turn away from a company like this because you won’t be able to offer anything new or interesting.

Instead, what you need to do is make sure you are injecting more cash into your business model for expansion. Once you fund the expansion you can use your new levels of profitability to pay the cost. You may be able to attract the interest of an investor to fund your business growth. If you can’t do this, you will need a loan. You can explore things like Ondeck loan reviews to find the right option here and ensure that you are getting a good deal. Be aware of interest rates as well as fees as this will determine whether a loan is the right choice for your company.

We hope this helps you understand some of the reasons why a business may fail on the market. If you take this advice, you can avoid some of the common problems and ensure that you don’t have to worry about your business taking the next hit. Instead, you can rise from strength to strength, growing your company. Remember, to ensure longevity, you need to have a plan for your business in place. Always start with a five-year plan and then build from there.

Operation Getting More Value In Business

As a business, providing customers with value for money. However, you mustn’t forget to ensure that your spending generates the best results too. Making your capital work harder will lift a great weight from your shoulders while also enabling you to pass some of the savings onto your clients.

So, how exactly can you ensure that all decisions are made in the best interests of your customers? Here’s all you need to know.

StrategyDriven Managing Your Finances Article | Business Financies
Assemble The Strongest Possible Team

The majority of business matters will be handled by your employees. Therefore, getting the recruitment process under control should be the first item on your agenda. This should be followed by an ongoing investment into their development both individually and as a team. The best ways to achieve this are through training and team building exercises. When they work harder, you’ll get more value for money on a daily basis. There is no stronger foundation for success.

Keep Assets In Good Health

Taking care of your business assets will unlock greater performance levels and prolong the lifespans. Keeping business vehicles in good health with the right gas oil is a significant step in the right direction. Meanwhile, computer system updates should bring telling results too. Even though the daily maintenance can have a very significant impact, you must learn to spot signs of faults. The sooner you act, the sooner you’ll restore their health. This should save a lot of money in the long run.

Research Your Purchases

You already know that customers want to get the best value for money when buying products or services. You should take a similar approach before completing your transactions. Simple ideas like using price comparison sites can work wonders. Likewise, you’ll want to check that any company you plan to do with business can be trusted. Falling victim of fraudulent activity or inadequate supplies will harm the venture and could be very hard to recover from. It’s best to be safe rather than sorry.

Know Your Demographic

Marketing is an area where only the best will do. Efficient marketing should be built around targeting a key audience. It’s impossible to impress everyone, but smarter research and insights will allow you to focus on the people that are likely to purchase. SEO, PPC, trade show stools, printed materials, and social media marketing can all be used to great effect. Remember to analyse the success of every campaign and make the necessary adjustments for ongoing success.

Avoid Bad Debts

While you obviously want to get as many sales as possible, you must not force thing when dealing with repayment plans. Good sales figures count for nothing if the money never arrives. Understanding bad debts and how to avoid falling victim to them is vital. While some people will default on payments, but you don’t want to let this become a major problem. Protect yourself in this manner, and your hopes of maintaining a positive cash flow will be greatly increased.

When the financial elements are under control, you can focus on actively driving the venture in the right direction.

5 Ways Healthcare Facilities Can Improve Their Financial Performance

StrategyDriven Business Performance Assessment Program ArticleHealthcare facility operating margins are under pressure from all sides. Uncompensated care of patients, slow paying insurance providers, reduced government reimbursement rates and rising costs are all contributing factors. Cutting staff and similar solutions risk quality of care and an extended wait time. Here are four ways healthcare facilities can improve their financial performance without adversely impacting patients.

Measure and Manage Based on the Right Metrics

The metrics you use as the yardstick for organizational performance affect how people act. Instead of seeking to get patients out as soon as possible, look at readmission rates. It would be better to invest a little more time and effort up front so that patients don’t have to come back later. This is so important that low re-admissions are necessary to join an accountable care organization or ACO. Instead of simply measuring the time it takes to discharge a patient, focus on finding the most efficient and error-free method of doing so. You want to ensure that acute patients receive appropriate self-care instructions and follow-ups so they don’t end up getting worse. You can also use data to identify opportunities for improvement, whether it is determining where to streamline operations or which profit-centers you may want to expand.

Work with Payors, Not Against Them

Healthcare facilities have no control over underpayments from government health programs. They can work with commercial and employer-based payers such as insurance carriers, and they can work with private pay patients. Healthcare facilities should take the time to understand their existing contracts and look for ways to better meet those contracts, so that they receive as much money back as possible. A common solution is renegotiating contracts.

A surprising number of uninsured patients are eligible for government programs. Work with them to sign them up for programs so that the facility can reduce its rate of uncompensated care or bad debt from those who cannot afford expensive ER and OR bills.

Reevaluate Your Suppliers

Work with your vendors to save money on supplies; that is the second largest expense in most healthcare facilities. Ask vendors about discounts you could receive simply due to the volume of items you already consume. Inquire about discounts if you ordered items in bulk and run inventory so that you don’t order items you don’t need.

Collect Data to Manage Labor Costs

In medical facilities, labor costs and labor-related costs may be more than half of all expenditures. Focusing on other areas is a waste of time if these expenses are not under control. The solution is to carefully track data on staffing and manage labor on a cost-per-patient-day level. Don’t over-staff one area and under-staff another. Make data-driven labor decisions whether hiring, firing, or assigning overtime. Hold regular meetings on managing labor rolls monthly, quarterly and annually. Don’t cut 10% across the board, but instead cut those individuals who are redundant or under-utilized. If labor costs are high in an area, you can look for third-party service providers who you could outsource the work to.

Use risk reporting software to find gaps in dynamic care, study financial trends, and determine the risks you may face based on resource allocation decisions. Then you won’t end up hurting patients with understaffing during a predictable peak demand or fall short of cash unexpectedly.

Industry surveys have found that finances are the number one concern of executives year after year. Following these tips can help you cut costs and improve revenue without hurting the quality of care patients receive.

5 Money Management Tips for Entrepreneurs

StrategyDriven Managing Your Finances Article
As an entrepreneur, you know how important money management is. Both inside and outside of the workplace, it can be the difference between struggling to make ends meet and paving your way for financial success. What’s more, it can be the difference between making and losing a profit. For this reason, money management simply must be a skill that you work on and try to become well versed with regards to.

If you feel that your career as an entrepreneur is being held back by a lack of knowledge on your part in the art of money management, then make sure to check out the five pieces of advice below.

1. Establish personal financial goals and steps to reach them

In order to turn over a profit in your career and grow your entrepreneurial portfolio as a result, you must, first, be able to manage your money on a personal level. Well, if you can’t look after your own money, how are going to be able to look after a business’s or even another person’s?

To learn how to look after your own money, you should establish some personal financial goals. It means setting targets and being proactive in the steps that you take to reach them. Whether this means aiming to have a specific amount of money saved by a particular time, or whether this means spending a certain amount in a week, you should set your targets and put plans into place so that you can reach and hit them. By becoming well versed in the art of goal setting and step taking as a person, you’ll succeed as an entrepreneur because these are skills that are exchangeable.

Something else that you should do on a personal level is to know what your credit score is. You’re never going to get anywhere as an entrepreneur if you don’t know what your rating is. What’s more, you could actually be held back from making future investments based on past discrepancies. It means that knowing where you stand with regards to credit is essential.

2. Get educated

If you want to become a genuinely great manager of money, then you need to educate yourself financially as often and as fervently as you can. It doesn’t necessarily mean taking a course in finance or accounting; this just means throwing yourself into tasks in which you have to be on the ball in a financial sense to stand any chance of success.

A good first port of call is to throw yourself into the deep end with investing and stock markets. By learning all about what it takes to study and manipulate ever-changing financial markets, you will soon understand how to stay afloat financially no matter what financial fiasco comes your way. By educating yourself in regards to bull and bear markets and what kinds of investments can and should be made within them, especially, you will set yourself up for a lifetime of financial strength and longevity. In this instance, you should check out Dr Kent Moors stock picks, specifically the information that details oil investment, as this will help you to have a better grasp on what, how and when certain investments should be made.

3. Learn to crunch numbers

By learning how to crunch numbers, you will be able to make sense of every financial figure that comes your way, which means that you’ll never be left dumbfounded by anything that you come across, and you’ll find yourself missing out on profit far less. To learn how to crunch numbers and reach financial figures easily, spend as much time as you can with your company’s accountants. Also, you could try playing games that rely heavily on one’s ability to read and understand financial patterns, one such game being poker.

Learning how to crunch numbers will also benefit you in your quest to become a great marketer. This is because number crunching will teach you what it takes to translate the impact of trends and then turn them into tangible results for yourself.

4. Become well versed in the art of organization

You’re never going to become an entrepreneur that has a reputation for being great with their money if you aren’t good at organization. It doesn’t just means learning how to organize your money, either. You should treat organization as if it is a way of life. You should know where everything is at all times, and you should know where you have to be at all times too.

In regards to chronicling your financial information specifically, start by organizing everything into categories. Put information of the utmost importance and outgoing payments that are deemed urgent at the forefront of your financial plans, and sums that can afford to be left unattended for a while on the back burner.

5. Find yourself a mentor

If you aren’t a professional accountant or financial advisor, you will struggle from time to time when it comes to money management. Sometimes you’ll feel like you can’t keep up with all of your monthly outgoings and incomings, and sometimes you’ll spend far more than you can afford to. To stop yourself from inflicting irreparable damage on yours or your business’s financial status, you should find yourself a mentor who can guide you. It could mean working alongside an accountant at your firm, it could mean hiring a financial consultant to help you from time to time, or it could simply mean talking to an older friend or relative of yours that has some experience in equity and asset holding.

If you want to be a successful entrepreneur, then learning how to manage money is an absolute must. To do this, you should ensure that your personal finance is as strong as it can be, you should educate yourself with regards to investment, you should learn how to number crunch, you should organize yourself in a business sense and as a person, and you should align yourself with a mentor. By doing all of this, you’ll be well on your way towards being able to handle even the largest sums of money.