Understanding the Important Steps of Medical Revenue Cycle Management

Medical revenue cycle management is important for all healthcare facilities. And that includes facilities that specialize in addiction treatment and behavioral healthcare. But what exactly is medical RCM and why is it important?

Revenue cycle management is when medical billing systems and clinical management systems interact. The information they gather is then shared with several sources, including patient payment vendors and patient statement systems.

Here are a few of the several steps involved in the RCM cycle.

  1. Eligibility and Verification

This RCM step checks to make sure a patient has valid insurance. The patient’s insurance is verified before the patient is allowed to make an appointment.

  1. Collect Payment Due

This RCM step involves collecting any co-payments or balances due from a patient. If a co-payment is due, the patient is required to pay before services are rendered. If there’s a balance from a previous service, then that payment is also due.

  1. Creating, Validating, and Submitting Insurance Claims

This RCM step involves electronically or manually creating patient insurance claims for services rendered. The claims are then submitted to an insurance provider or other vendors responsible for payment.

  1. Making Adjustments

Sometimes a claim has errors that need correcting. This step in the RCM process takes care of those mistakes, resubmits the claim, and adds any additional information that’s requested.

  1. Sending Patient Statements

The amount not covered by insurance is passed on to the patient. In this step, an electronic notice or printed bill is sent to the patient. Payment is then collected and data concerning the process from start to finish is collected.

Keeping Track of the Healthcare Cycle

Medical revenue cycle management helps keep healthcare facilities running smoothly. AZZLY provides comprehensive addiction treatment and behavioral healthcare-specific RCM.