What Exactly Is Healthcare Revenue Cycle Management

Every healthcare system is known for treating patients and saving lives. These organizations need to create successful policies and processes for staying financially ahead of the game. That is where revenue cycle management comes into the picture.

An effective Revenue Cycle Management (RCM) strategy has many benefits for the healthcare organization.  Without a good RCM, your organization can suffer from poor billing practices and overall healthcare management, which can ultimately result in revenue loss for your organization.

Even more importantly, as healthcare organizations move away from the fee-for-service toward the value-based service model, the ability to streamline operations can significantly benefit an organization by helping them remain profitable while focusing on the quality healthcare that every one of their patients deserves.

Below we will look at the healthcare revenue cycle management system and why it’s vital to sustaining a successful value-based healthcare organization.

Let’s get started!


What is Healthcare Revenue Cycle Management?

Healthcare Revenue Cycle Management (HRCM) helps healthcare organizations increase profits and maintain stable financial health within the company. Essentially HRCM takes the patient’s complete financial journey from start to finish and manages the entire process.

RCM technology helps with automation, digital patient intake forms, medical billing, collections, and management of billing information.

These features allow hospitals, clinics, and specialty practices to operate more efficiently so that the staff can focus on giving their patients the best care possible.

Related Links: Learn about Rainbird Healthcare Business Service today!

Fee-For-Service Vs. Value-Based Healthcare 

Explain the differences between the two, why FFS was phased out, why VBH ultimately succeeded, and how it ties into HRCM.

Fee for Service (FFS) healthcare is the most common payment system in the healthcare industry.  With this model, physicians and providers are driven by the number of services they provide because this is how they get reimbursed.

There is no bundling of payments in this model.  Therefore, insurance companies are billed for every single thing that happens, including tests, procedures, treatments, routine patient visits, hospitalizations from patients, and consultations.   As you can imagine, FFS has many drawbacks and is not a fan-favorite of many healthcare organizations and patients alike.

On the other hand, when an organization follows a value-based healthcare model, the doctors and hospitals are paid based on the patient’s overall health outcomes.  With a value-based system, providers are rewarded for assisting patients with improving their health, which will ultimately reduce incidents of chronic disease and help them live longer healthier lives.

The value-based healthcare model is different from the fee-for-service model because doctors aren’t paid for the amount of healthcare they deliver but rather for the value of care that they provide.  As you can imagine, a value-based healthcare system is much better for society in the long run.

The Benefits of HRCM and a Value-Based Healthcare System

what is HRCM?

There are several benefits to having a strategic HRCM used in conjunction with a value-based healthcare system. Below we will look at some of these benefits and how they affect healthcare organizations in America.

Quality of Care 

By having a solid HRCM, physicians and providers can use the efficiencies of technology provided to focus more time on patients and give them the best care possible.  Even though it is inevitable that healthcare organizations spend time on preventative-based patient services, they don’t have to spend as much time on managing chronic disease patients because so much emphasis is placed on the value of healthcare from the very beginning.

Cost of Care

When you help people manage chronic diseases, less money ultimately has to be spent.  A value-based healthcare system can significantly reduce the costs of hospitalizations and medical emergencies.

Receiving better care means healthier patients.  Healthier patients mean less money is needed to spend on prescription drugs to help with conditions like diabetes, high blood pressure, and obesity.

Fewer doctor’s visits, procedures, and medical tests all contribute to a cleaner and more efficient workflow for the staff and a well-planned out RCM.

Access to Quality Care with Improved Technology

The way patients interact with insurance providers has been possible with advances in technology.  Insurance companies typically provide most of the financial information that patients need when considering healthcare costs.

Instead of patients experiencing long telephone hold times to talk to a representative, they can now use online chats with live people, chatbots, and online price quote tools.

Efficient Medical Claim Resolution

One of the most significant reasons to have a strategic RCM program in place is to increase revenue for your organization.  One of the biggest examples of this is having an efficient RCM that can help in resolving medical claims.

Overall you will experience money coming in quicker and more consistently, lower expenses, and improved office efficiencies.

Efficient Patient Pre-Registration

Pre-registration is one of the first steps to optimizing the revenue cycle management process.  During this first step, your office staff will create an account for the patient with their crucial medical information and insurance coverage.

This step is crucial because the ability to fill out insurance info correctly, verify proper care for the patient, and collect payments upfront help reduce the workload down the road and ultimately help cut down on claim denials.

Enabling Patient Access

Another critical first step to revenue cycle management is prioritizing the patient’s access to their information.  For example, once the staff member does the intake, online portal information such as usernames and passwords can be sent to the patient’s email address to log in and access their information at any time.

Things such as test results, a summary of doctor’s visits, access to pay bills, and much more can significantly help increase customer satisfaction levels.  Everything is convenient and accessible to the patient at all times.

Modern Software That Verifies Insurance

Having modern software that can verify insurance is a fantastic way to reduce errors in the beginning.  Front-end tasks such as registrations, eligibility, and authorizations are some of the biggest reasons claims get denied.  This can be prevented by utilizing some of the technology in the healthcare field today.


Healthcare revenue cycle management will continue to evolve as changes in the healthcare industry advance.  As healthcare organizations quickly adopt the value-based care model, new technology will adapt and create highly efficient environments for healthcare organizations to thrive.


Get in touch with one of our experts today for more information on how Rainbird Healthcare Business Services can help implement a strategic healthcare revenue cycle management program.


Related Links:  Rainbird Healthcare’s Approach to RCM

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