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.
AAPC defines revenue cycle management as follows: “Revenue cycle management (RCM) is the process healthcare organizations use to manage financial operations related to billing and collecting revenue for medical services. RCM begins when a patient schedules an appointment and ends when the account balance is resolved through reconciliation of insurance payments, contractual adjustments, write offs, or patient payments.”
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!