Understanding and Improving Your RCM

Understanding and Improving Your RCM

The management of your practice’s revenue cycle is the foundation of your financial viability, yet physicians often don’t fully understand the very process that determines the financial health of their practice. Physicians are trained to treat patients and rarely have the financial background required for the most efficient and profitable revenue cycle management. Yet the rising cost of healthcare requires even the busiest physician and their practice to place an increased emphasis on productivity, waste reduction, and how those components of the business are impacting their operating margin or bottom line.


Lack of knowledge and understanding of your RCM generally results in poorly trained and educated employees, and insufficient communication and workflow. Reimbursement claims and organizational revenue can be greatly affected by employees not understanding your revenue cycle. Not only can this affect your RCM, but these problems can extend into other areas of the business too. Choosing to learn and understand your revenue cycle will improve the organization communication, revenue, and workflow as a whole.

Management of your revenue cycle process begins prior to the point when a patient schedules an appointment and extends beyond when you are reimbursed or paid for the service. Although it seems simple, there are many components of the revenue cycle that can complicate the process, slowing or stopping the cycle. Understanding the revenue cycle process will enable you to build knowledge of the business side of your practice and determine the areas of opportunity for improvement in your practice, and in turn improve the efficiency and effectiveness of your revenue cycle thus boosting revenue and profitability.

  • Coding Process & Denial Management: Improper coding results in denied claims that delay the reimbursement process and require you to determine the problem, resubmit the claim, or begin the appeals process.
  • Collections: Your practice surely already has a collection process in place. But have you explored better, more efficient processes to collect from insurance companies and from patients? Collecting from patients is the hardest and most expensive revenue to chase. Having a cohesive strategy that is measurable is a must.
  • Office Staff Efficiency: Does your office staff run the practice efficiently? What are your labor costs and are they within acceptable margins? Does maintaining an internal billing staff cost you more than it would to outsource to an expert?
  • Auditing and Compliance programs: Does your practice have these programs in place to determine if policies and procedures are being followed correctly? More importantly, are you doing so with accuracy and making sure you are being paid what you should be paid?

The healthcare field is an ever-evolving industry with constant changes in technology requirements, security and privacy issues, and the constant barrage of government and payor regulations. Taking the right steps to understanding and improving the management of your revenue cycle can have great benefits to healthcare organizations, most notably bringing more money into the practice. For some healthcare organizations, outsourcing the management of your revenue cycle is the most effective and efficient choice. This allows experts like us to use our knowledge and experience to maximize reimbursements, improve compliance, increase revenue, and boost your overall profitability.