In simple terms, RCM refers to the steps that healthcare organizations must take to receive payment for services rendered. Historically viewed as a straightforward back-office function, RCM now touches every aspect of a practice.
A complete RCM strategy is comprised of three main functions:
1) Generate revenue: Practice survival and sustainability depend on the ability to generate revenue. By reducing gaps and inefficiencies in scheduling to maximise reimbursement, practices can achieve this goal, but it requires a proactive approach to both scheduling and capture of all necessary patient information and copay up front. When this function of revenue cycle is optimised, practices can increase their revenue by minimising the number of no shows.
2) Capture revenue: Once a patient is called from the waiting room, the clinical encounter begins and extends through the time a patient leaves the appointment. The activity that occurs during this time-frame is foundation to a practice’s ability to capture revenue and must be thoroughly recorded. Accurate and complete documentation of services rendered and proper coding of those services is required to receive payment at the highest level.
3) Collect revenue: In general terms, back office billing functions enable a practice to collect revenue and round out the RCM cycle. Included in this category are the steps associated with billing, posting and collection of payments and should be viewed by practices as the last step of the RCM process.