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."^[1] 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).

Information

The Revenue Cycle Management process begins when a patient schedules an appointment and it ends when the healthcare provider has accepted all payments.^[2] 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.^[3]

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.^[4]

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.^[5]

Medical Coding

An important aspect of the revenue cycle is compliance with medical coding regulations. Optimal coding compliance results in higher revenues and decreases claim denials from insurance companies. By achieving optimal coding, a medical practice can prevent disruption of the medical flow and avoid regulatory penalties.^[6]

References

1. "Healthcare Financial Management Association, Online Glossary".
2. "Revenue Cycle | Patient Business Services | OHSU". Ohsu.edu. 2013-04-16. Retrieved 2015-08-26.
3. "Show Me the Money... A Look at the Revenue Cycle from the Billing Perspective". Library.ahima.org. Retrieved 2015-08-26.
4. Murphy, Brooke. "25 things to know in revenue cycle management". www.beckershospitalreview.com. Retrieved 2016-10-27.
5. "Healthcare IT Market size worth over $230bn by 2023: Global Market Insights Inc. |". Medgadget. 2016-10-19. Retrieved 2016-10-27.
6. "Regulatory Impact on Revenue Cycle Management— Think You're Prepared? Think Again". Retrieved 12 October 2016.