Revenue Cycle Management


Physician-based organizations face numerous challenges simultaneously — from patient care to financial management, maintaining consistent standards is essential. Tower Physician Solutions helps your organization verify and understand the reliability of the revenue cycle management (RCM) process, enabling you to implement necessary safeguards. This process protects the integrity and overall health of revenue, preventing losses through recoupments, interest, fines, and penalties.

What Is Revenue Cycle Management?

Revenue cycle management is the medical billing procedure that navigates the reimbursement process for services rendered to patients, from initial service to payment receipt. This involves more than just submitting claims and awaiting payment; proper staffing and systems are crucial for creating efficiency within the RCM process. Misappropriated billing and lack of diligent resolution can lead to increased costs.

The revenue cycle process in healthcare includes:

Registration: The first step in the patient financial process is collecting and accurately entering demographic data, such as the patient’s name, address, and insurance information. Incorrect entries can impact claim accuracy, leading to denials. Reliable staff must ensure that information is up-to-date at every encounter, as the provider of service bears the responsibility for compliance and accuracy of each claim.

Medical Coding: After each patient encounter, a code is required to convey the performed services to the payor for reimbursement. Coding methods vary across organizations; some have medical coders who review documentation and append the code, while others rely on providers to code each encounter. Regardless of the method, correct and thorough coding is vital for claim payment and reimbursement.

Medical Billing: The services are then ready for claims creation and submission to the payor for reimbursement. The billing team may conduct additional reviews to address billing-specific concerns noted during claim scrubbing. The claim is then submitted, but reimbursement is not guaranteed. Payor-specific policies may lead to rejection or denial of claims, delaying reimbursement. Post-submission work includes claim rejection and reprocessing, denial resolution, and patient collection processes related to coinsurance, claims responsibility, and deductibles. The RCM process is complete only when the claim is paid in full or adjusted as non-collectible.