Revenue Cycle Management in Healthcare Explained

Revenue Cycle Management (RCM) in Healthcare Explained.

Revenue Cycle Management means 'getting the bills paid' for hospitals, doctors and other healthcare providers.

The video explains the steps in RCM: 1) Pre-Registration, 2) Registration, 3) Charge Capture, 4) Utilization Review, 5) Coding, 6) Claim Submission, 7) Remittance Processing, 8) Follow Up and 9) Patient Collections.

RCM is a $29B a year industry and Becker's Hospital Review has a list of 354 healthcare RCM companies in America.

Accordingly, the RCM industry is highly fragmented meaning 1) there are low barriers-to-entry for starting an RCM company and 2) the competence/performance of RCM companies is highly variable.

RCM effectiveness is measured in Accounts Receivable (AR) Days. Hospital AR Days range from 30 to 70, which for a $3B per year hospital system is a difference of $328M in cashflow.

RCM is so complicated that many physicians are selling their practices to hospital systems so that the hospital can take over the RCM and do a better job with it.

Related AHealthcareZ Videos:
Utilization Review: https://youtu.be/pIM35-zspl4?si=xfds0PKnoxQx2ijT

Medical Coding: https://youtu.be/fqNBNE_YSro?si=KYYtOHTvoN7lmHPp

Sources:
https://www.futurewiseresearch.com/healthcare-market-research/Healthcare-Revenue-Cycle/9354

https://www.beckershospitalreview.com/lists/354-revenue-cycle-management-companies-to-know-2024.html

https://revcycleintelligence.com/features/breaking-down-the-back-end-revenue-cycle-key-best-practices

https://blog.pmmconline.com/blog/revenue-cycle-management-explained

https://www.amnhealthcare.com/amn-insights/revenue-cycle/blog/an-experts-perspective-on-becoming-a-clinical-documentation-integrity-professional/

https://www.marketplacer.com/blog/how-do-you-identify-a-fragmented-industry/

https://www.medisysdata.com/blog/calculating-ar-days-in-medical-billing/#:~:text=According%20to%20hospital%20benchmarks%2C%20AR,medical%20billing%20or%20collection%20processes.