The Keys to Successful Healthcare Revenue Cycle Management

July 16, 2018

Keeping pace with the changes in healthcare RCM can seem like a daunting task that takes considerable expertise, time, and resources. Today, medical professionals spend more money billing and collecting than in any other industry, and even with powerful management software and trained employees, maximizing clinic profits can be a challenge.

Creating a well-maintained healthcare revenue cycle management process can make a huge difference in a clinic’s bottom line but how do you know if your RCM process is doing what it should?

Measuring Effectiveness in Healthcare Revenue Cycle Management

Understanding the effectiveness of your current healthcare revenue cycle process is key to identifying what needs change or improvement. In general there are four pillars to successful RCM in healthcare:


They are the backbone of a well-managed revenue cycle. Healthcare veterans have experience in coding, compliance, electronic data exchange, customer service, billing/ collections, and more, and are the ones capable of managing every aspect of a business.


When followed with strict adherence, the RCM system will guarantee results. The process is made up of data collection, claims submission, AR processing, automation, specialist prioritization, and other steps. Working with information, structure and discipline is what produces reliable higher performance.


It is used across the entire revenue cycle process. It allows for effective tracking, automation, and interaction, and can be used by a large pool of employees with minimal expertise. It enables every task in the process to be performed quickly, accurately and consistently.


It takes good data to improve any revenue cycle performance. Having access to critical data delivered in simple reports will pinpoint problems and identify opportunities. In today’s market, BI is critical to increasing both efficiency and profits.

Healthcare Revenue Cycle Flowchart

The RCM process is complicated – to assess the quality of your RCM process there are many tasks and functions that need to be looked at together. This healthcare revenue cycle flowchart provides one way of thinking about the elements of the RCM process.

Healthcare Revenue Cycle Management Flowchart

Current Challenges in Healthcare Revenue Cycle Management

Every clinic is facing a set of core challenges that require a thoughtful approach to overcome. The old notion of ‘billing and collections’ is changing and expanding – the revenue cycle process now encompasses almost every aspect of a practice. It is becoming more automated, regulated and complex. These are a few of the challenges clinics need to consider to create a healthy RCM process:

  • Maximizing performance – Declining reimbursement and rising costs means practice needs to capture every earned dollar.
  • Minimizing cost – Payment per claim is flat if not declining, and RCM costs are only increasing.
  • Compliance – More complicated than ever, and with higher stakes.
  • Business intelligence – Increasing the need for sophisticated data to drive business.
  • Integration – RCM platforms rely on an expanding ecosystem of technologies that have to function in tandem.
  • Migration to Value-Based Reimbursement – New RCM processes that are different from Fee-For-Service.
  • Direct patient payment – With the increasing costs of health insurance, this is a large source of revenue.
  • Staff recruitment and retention – It is harder to find and keep talent (low end salaries get less skilled workers, higher skilled workers are in demand and harder to retain).

Improving Your Clinic’s Healthcare Revenue Cycle Management

If you are looking to improve the way your clinic manages its revenue cycle, you might be considering changing or implementing new practice management software or outsourcing your RCM entirely – both of these are good options to take your healthcare RCM process to the next level.

For even more information about healthcare revenue cycle management – including RCM best practices for every step of the revenue cycle – you can download our comprehensive Revenue Cycle Management eBook for free.

Download RCM eBook

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