Revenue Cycle Management

Revenue Cycle Management is the process used by healthcare systems in the United States to track the revenue from their patients from their initial appointment or encounter with the healthcare system to their final payment of balance. The cycle can be defined as, "all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue." It is a cycle that describes and explains the life cycle of a patient (and subsequent revenue and payments) through a typical healthcare encounter from admission (registration) to final payment (or adjustment off of accounts receivables).

The Revenue Cycle Management process begins when a patient schedules an appointment and it ends when the healthcare provider has accepted all payments. Errors in Revenue Cycle Management can lead to the healthcare provider receiving delayed payments or no payment at all. Because the revenue cycle process is complex and subject to regulatory oversight, healthcare providers can turn over their Revenue Cycle Management to companies that handle this complex process 24/7 with specialized agents and proprietary technologies to manage healthcare provider revenue cycles.

Medical billing is getting increasingly more complicated, especially as medical code guidelines are making the switch from ICD-9 to ICD-10. Proper Revenue Cycle Management ensures that billing errors are reduced so that reimbursements from the insurance companies are maximized. Revenue Cycle Management teams are responsible for maintaining compliance with coding regulations, such as the ICD-10 code update. Using the right coding for services rendered by a practice ensures that insurance claims can be processed and that the practitioner is compensated for all of their services rendered. A revenue cycle management team is able to handle this, rather than having the doctor take care of patients and learn new medical coding protocols.

In 2014 the revenue cycle management market was valued at $18.3 billion and is expected to grow to $32.2 billion by 2019.

For remittance received in 2014, the average physician practice took 18 days to generate a claim after the date of service and had an 11% denial rate.

Revenue cycle management is often considered a segment of the greater healthcare IT industry which includes HIS, RIS, EHR, PACS, CPOE, VNA, mHealth, healthcare analytics, telehealth, supply chain management, CRM, fraud management, and claims management.

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