Resource Library & Practice Insights

They are pre-registration, registration, insurance verification, charge capture, medical coding, claim submission, adjudication, payment posting, denial management, A/R follow-up, patient billing, payment collection, and reporting and analytics.

Revenue cycle management (RCM) covers patient registration, insurance verification, claims processing, payment collection, and financial reporting. The goal is to ensure efficient billing and faster reimbursements while minimizing denials and revenue losses.

Revenue life cycle management refers to the entire financial process of patient care, from appointment scheduling to final payment collection. It streamlines billing workflows, improves cash flow, and enhances operational efficiency for healthcare providers.

Aim for a denial rate below 5–8%. If it trends higher, review the top denial reasons, update your claim edits, and shore up documentation and prior authorization.

The 4 P’s of RCM are Patients, Providers, Payers, and Processes. These elements work together to optimize billing accuracy, accelerate payments, and reduce administrative burdens in healthcare financial operations.

Tighten claim scrubbing, align coding with payer policies, ensure prior auth, and attach required documentation. Track edit failures weekly.

The basic revenue cycle includes patient intake, claims submission, payment processing, and revenue reconciliation. Efficient RCM automation ensures faster reimbursements, fewer denials, and improved financial performance for healthcare organizations.

Days in A/R, first-pass resolution, denial rate, net collection rate, and clean claim rate. Review weekly and monthly with owner assignments.

Many providers outsource pre-auth, coding audits, eligibility, or A/R follow-up to reduce backlogs and improve speed to cash, while keeping oversight in-house.