What is meant by revenue cycle management (RCM) in healthcare?

The concept of revenue cycle management (RCM) in healthcare refers specifically to the financial process utilized by healthcare systems to effectively manage the claims processing cycle. This includes the steps of identifying, capturing, and collecting revenue for services rendered. RCM encompasses various processes that ensure timely and accurate billing for patient care, starting from patient registration, navigating insurance verification, coding services correctly, submitting claims to payers, and finally handling collections.

This comprehensive management of the revenue cycle is vital for the financial health of healthcare organizations, as it allows them to provide quality care while ensuring they are compensated for their services in a timely manner. By focusing on the entire cycle from patient care to final payments, a well-executed RCM strategy can enhance operational efficiency, minimize claim denials, and improve cash flow for healthcare providers.