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Revenue Cycle Management

Advice on Revenue Cycle Management for Medical Practices

Revenue cycle management (RCM) is the process used in healthcare to monitor and collect money from patients. Revenue cycle management starts when a patient is scheduled for a clinical visit and ends with the final payment for the healthcare services provided. The revenue cycle is “all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue,” according to the Healthcare Financial Management Association (HFMA). The highest possible reimbursement for services is ensured by using best practices in the revenue cycle.


Optimal Techniques to Enhance RCM

 Follow are the main techniques to enhance Revenue Cycle Management (RCM)


Center the Process Around the Patient

Revenue cycle management optimized healthcare facilities understand the need for improved patient relationship management. The practice gains a patient’s loyalty if the staff takes proactive steps to raise patient satisfaction and foster a good rapport. The patient should be given written and verbal explanations by the staff about their financial obligations, available payment methods, and what to anticipate from their visit. The more interactions patients have with staff about the medical billing process, which many patients find confusing, intimidating, and frustrating, the more likely it is that they will pay the provider back. 

Or get practice audit and reporting services from Optimedservices.


Obtain Payment From the Patient Before Providing Services.

When patient financial responsibility is unpaid or paid late, healthcare revenue cycles slow down or stop. Hospitals and medical practices run the risk of not getting paid in full for the services they provide. Since high deductible insurance plans are the norm, it is unfortunate that more than half of patients with outstanding medical debt never pay it off. Sadly, this situation is unlikely to improve anytime soon.


Technology Investing

It might seem as though Medicare and Medicaid will always reject any claim you submit. If you haven’t made an investment in front office service to keep you abreast of payer requirements and diagnostic code changes, this might not be too far from the truth. When you do receive reimbursement, you might discover that it’s for less than you originally requested.


Investigating unpaid claims, fixing errors, and re-submitting them all take time. If your practice is subject to a TPE from Medicare, the cost is even higher. Prior authorizations, eligibility, medical coding, and billing can all be streamlined with automated software systems. Modern technology with automation expedites reimbursements while reducing the amount of time staff spends resolving unpaid claims.


Denial Control

If the aforementioned best practices are not followed, claims may be rejected. Any hospital or medical practice must monitor and track denials in order to spot trends and determine their underlying causes. The entire staff should participate in a denials prevention program that emphasizes standardized procedures to reduce the risk of denials.

Best practice denial management programs can decrease the following:

accounts receivable, boost cash flow, reduce the volume of denials, and lower the cost of collection, But you can control all these with Optimedservices


Quickly Submitting Claims

Many healthcare organizations miss filing deadlines and don’t submit claims in a timely manner. Medicare permits one year from the date of the service for the filing of claims, whereas many private insurance companies only permit 90 days. Claims go unpaid if deadlines are missed, and the practice is forced to write off clinical services. To ensure that these deadlines are met, processes must be in place.



2 thoughts on “Advice on Revenue Cycle Management for Medical Practices

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Iqra Haseeb


Organised and efficient Team leading Manager, supporting corporate level officers and senior management personnel with demonstrated expertise in financial and operational leadership. Adroit professional exemplifies multi-disciplinary managerial skills in process procedure and policy improvement initiatives. Accomplished in workflow optimization techniques implementation which increases productivity, reduces labour, and maintains business integrity and quality of service.


Extensive Client Coordination., Conducts business analysis to create value, Provide Support in creating or enhancing the business, Develop and manage strategic partnerships to grow business, Provide Insights or Conduct Studies related to Market or Business Operation related problems, Provide assistance in operating and handling the business, Develop and structure concepts, strategies, automating and scaling the business


Developed and implemented favourable pricing structures balancing firm objectives against customer targets., Education Coordinated innovative strategies to accomplish marketing objectives and boost long-term profitability., Reached out to potential customers via telephone, email and in-person inquiries., Worked with existing customers to increase productivity of  services.

Sharjeel Khan


Having 10 years of experience in the Medical Billing Industry & up to date with Government, Commercial, Automobile & Workers Compensation Payer guidelines throughout the U.S.
Strong knowledge of claims procedures and coding, account receivable/collection, Denial Management, Credentialing/EDI Enrollments and Revenue Cycle Management. Experienced in Electronic Claim (5010) Loop and Segment Editing, Creating Paper to Electronic Claims (EDI 837), Resolving EDI Rejections through Practice Management & Clearing house, creating invoices, customized provider reports, Auditing, processing insurance & patient payments, and pursuing past-due balances through unique & proven RCM process and Data Management.


ICD-10-CM, CPT, Coding Guidelines, Diagnosis Coding, Compliance, Facility/Professional Coding, Complete Revenue Cycle Management, Telehealth or Virtual Visits, Provider Education, CMS-1500, Upper hand in almost every top PM/EMR/EHR Software used, and many more...


Behavioral/Mental Health, Neurology, Family/Internal Medicine, Infectious Diseases, Pulmonary & Sleep Medicine, Pain Management, Physical/Sports Medicine and Rehabilitation (Physiatrist), Chiropractic, Podiatry, Radiology, and much more.

The Full-Service Bundle includes;
  1. Medicare for both one practice county and one provider
  2. Medicaid for both one practice location and one provider
  3. BCBS PID for both the practice and one provider
  4. RailRoad Medicare for both one practice county and one provider