Understanding the Health Care Revenue Cycle and Management Needs

by | Apr 6, 2020 | Healthcare

Urgent care RCM services compose a critical part of any healthcare facility’s workflow. Insurance eligibility checking, co-pay collections, exception analytics on patient claims, bill preparation, claims submission, payment posting, and accounts receivable management are the essential pillars that comprise comprehensive revenue cycle management.


As part of an efficient revenue workflow, each patient account should be group and repriced according to the accurate contract rate. Once the patient accounts are group correctly, each account is analyzed to compare the amount the hospital or other healthcare facility paid compared to the contract amount. After the analytical process, billing opportunities are confirmed and collected. RCM services can help at each step of the process.

Eligibility Check

Today’s economic climate and current state of healthcare cause many patients to switch healthcare insurance providers more often. The uncertainty of insurance providers poses problems for your urgent care RCM services. As part of comprehensive revenue cycle, there needs to be patient insurance eligibility checking. Insurance eligibility determination ensures the insurance company is being held responsible for covering the procedures rendered.

Coding, Submission, Tracking, and Posting

The need for seasoned and certified medical billing coders is crucial, as they must also be subject experts and understand your facility’s professional needs. The claim submission process has to be free of errors to maximizes returns and implemented as efficiently as possible. Once claims are submitted, active tracking of paid and unpaid claims is critical to effectively collected outstanding revenue.

Accounts Receivable Management

The accounts receivable process of the cycle includes effective front-end monitoring and accurate tracking of the claims that must be resubmitted. Also, denial management must be performed to understand the reasons for insurance denials, and when to initiate the insurance appeal process.

A comprehensive revenue cycle management workflow will increase cash flow for your healthcare facility by increasing collections, reducing denials, and identifying coding errors.

For more information visit PulseCheck.

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