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General Questions about Outsource RCM

In healthcare, Revenue Cycle Management (RCM) refers to the financial process that tracks patient care episodes from registration to payment, essentially managing the flow of revenue for a healthcare provider. It encompasses all administrative and clinical functions that contribute to revenue generation.

RCM outsourcing gives you access to the specialized expertise you need to identify red flags in your revenue cycle, streamline your billing processes, and implement cost-effective strategies to help improve your bottom line and achieve your goals for growth.

The primary reason many companies outsource manufacturing is to reduce production costs. Outsourcing manufacturing can lead to reduced production costs due to lower labor expenses, access to cost-effective raw materials, and economies of scale offered by specialized manufacturing facilities.

Outsourcing medical billing offers numerous advantages for healthcare providers, including cost savings, increased revenue, improved efficiency, and enhanced patient care. By delegating billing tasks to a specialized provider, practices can focus on their core competency of patient treatment while benefiting from reduced operational costs, faster payments, and fewer billing errors.

RCM Cycle Steps in Medical Billing
  • Patient Registration. The first step is collecting patient details, including personal and insurance information.
  • Insurance Eligibility Verification.
  • Medical Coding & Charge Capture.
  • Claim Submission.
  • Payment Processing & Denial Management.
  • Patient Billing & Collection.
  • Reporting & Analysis.

It helps practices save time and money by lowering the number of denied claims and making it possible for patients to make payments online. It connects the commercial and clinical sectors of healthcare. RCM systems are used by healthcare organizations to store and manage patient billing information.

The goal of revenue cycle management is to ensure accurate and timely reimbursement for the healthcare services a practice provides.

The 4 P's of revenue cycle management are Patient, Provider, Payer, and Process. Each plays a vital role in RCM efficiency. Patient: Accurate data collection and understanding of financial responsibilities.

The three main components of the revenue cycle include:
  • Front-end processes, like patient engagement and registration.
  • Middle processes, like resource and service tracking.
  • Back-end processes, like claims processing and revenue collection.
Consider everything from the very first patient interaction to the final payment, and think about staff engagement and billing resources, too.
  1. Simplify patient access.
  2. Understand payer rules.
  3. Improve payment collection processes.
  4. Workflow automation.
  5. Staff engagement and training.
  6. Focus on the patient experience.

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