Glossary · Metrics and close
What is revenue cycle management?
Revenue cycle management is everything between a patient's first contact and the last dollar collected: intake, eligibility, authorization, claims, payment posting, denials, underpayments and reconciliation.
Example · fictional data
The revenue cycle in three phases, and what happens in each.
The revenue cycle
| Phase | Work | Where it fails |
|---|---|---|
| Front end | Referral and document intake, eligibility, prior authorization | Coverage and authorization denials |
| Mid-cycle | Coding, charge capture, claim scrubbing, submission | Rejections and coding denials |
| Back end | Payment posting, denials, underpayments, patient balances, reconciliation | Unworked denials, short pays, unmatched money |
- Most back-end problems start at the front end. A denial worked well is good; a denial prevented at intake is better.
Every healthcare provider that bills insurance runs a revenue cycle, whether it calls it that or not. RCM is the work of making that cycle fast, complete and accurate, so that the money owed for care is collected.
The phases
- Front end: patient intake, eligibility verification and prior authorization, before the service.
- Mid-cycle: coding, charge capture and claim scrubbing, turning care into clean claims.
- Back end: payment posting, denial management, underpayment recovery, patient balances and reconciliation.
How it’s measured
Days in A/R, clean claim rate, denial rate, A/R aging, and collections against what was expected.
Early access
Run your revenue cycle as workflows.
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