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Revenue Cycle Management (RCM) is a specialized professional discipline that is used by a range
of businesses to manage revenue, increase net collections and assure prompt payments.
In the healthcare industry RCM is driven by factors such as medical procedure codes, detailed
documentation, reimbursement guidelines, electronic record transfers and data security.
RCM functions are enabled—or enhanced—by medical billing software that replaces the tedious manual
processes that can generate errors and foster fraud. Additionally, RCM companies that serve medical
practices employ trained specialists and billing experts to manage key milestones in the revenue cycle:
Capturing and reviewing information needed to generate a medical claim
Coding each intervention to accurately identify treatments or procedures
Editing information to conform with acceptance guidelines of claims payers
Using medical billing software to file claims electronically and accurately
Posting payments received and making deposits into practice bank accounts
Posting denied claims, meeting payer objections and resubmitting claims
Monitoring payment intervals, analyzing underpaid claims and managing A/R
Managing patient responsible billing and making payment arrangements
Professional RCM processes produce specific benefits for hospital-based physician practices, such as
sustained cash flow, reduced expenses, maximized reimbursements, improved liquidity, increased
profitability and assured compliance.