Medical Billing and Coding Healthcare Blog

PGM Billing provides a number of services to physician practices, ambulatory surgery centers, labs and other providers. One of these services is revenue cycle management, or RCM.

When organizations ask what PGM can do for them and we mention our extensive experience with providing revenue cycle management services, it's not unusual to hear the question, "What is revenue cycle management?"

We thought it would be helpful to address that question in an objective manner by sourcing the words and knowledge of other RCM experts.

HBMA — the Healthcare Billing & Management Association — says the following: "Revenue cycle management (RCM) is the process that manages claims processing, payment and revenue generation. It entails using technology to keep track of the claims process at every point of its life, so the healthcare provider or medical billing company doing the medical billing can follow the process and address any issues, allowing for a steady stream of revenue. The process includes keeping track of claims in the system, making sure payments are collected and addressing denied claims. RCM encompasses everything from determining patient insurance eligibility and collecting co-pays to properly coding claims using CPT and ICD-9 codes."

MedPageToday's Rosemarie Nelson writes: "Revenue cycle management (RCM) is the lifeblood of every practice. Effective patient registration, insurance and benefit verification, charge capture, and claims processing are essential to maintaining viability."

Healthcare IT News defines RCM as: "...the process of managing claims, payment and revenue generation. RCM encompasses everything from determining patient insurance eligibility and collecting co-pays to properly coding claims."

The Houston Chronicle states the following: "In a hospital context, the purpose of revenue-cycle management is to optimize the patient financial experience along the entire continuum of care. This means that various patient financial touchpoints — including insurance contracts and the collection of co-pay and deductible expenses — require the patient's active involvement. Hospitals retain a strong incentive to harmonize the patient financial experience to improve patient satisfaction and to reduce the risk of denied charges by insurance companies.

A Healthcare Information and Management Systems Society (HIMSS) report (pdf) says RCM ..." extends beyond patient billing and collections; it incorporates checking eligibility, collecting complete patient demographics, benefits verification, capturing charges, coding, claim submission, collecting and posting payments from patients, denial management, reporting and data analysis. The main objective is maximizing revenue while optimizing patient satisfaction."

If you still have questions about what RCM is or how PGM's revenue cycle management services can improve your organization's financial performance, please contact us today!

As part of "Road to 10," the online resource built by the Centers for Medicare & Medicaid Services (CMS) with input from providers, CMS has published a series of ICD-10 interactive case studies.

In each case study, users are presented with a sample medical case and asked several questions about how to properly document and code that case in ICD-10.

After completing the questions, users are presented with their results with comparison to peers, as well as a sample way to code the case in ICD-9 and ICD-10.

To date, CMS has released the following case studies:

Looking for more free ICD-10 resources? PGM Billing, a leading provider of physician practice and ambulatory surgery center billing and revenue cycle management services, recently launched a comprehensive "ICD-10 Code Lookup Tool" that allows users to easily convert ICD-9 to ICD-10 codes and vice versa. Bookmark it so you can easily access the conversion engine for practice leading up to the Oct. 1, 2015 transition date and use once the transition from ICD-9 to ICD-10 is made.

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