Healthcare revenue cycle management is a complex process. Adding to the complexity is the fact that rules and regulations as well as codes keep changing regularly.
RCM begins when a patient makes his/her appointment to visit a physician. And it ends when all payments due to the physician for services rendered are collected from payors and patients. The process from start to finish is rather complicated.
The nature of the patient population, the needs of the patients at various stages, and the norms for insurance coverage add to the challenges the providers face to keep the practice running.
Medicare and commercial payors insist on medical necessity for foot care and thus, coding in podiatry specialty and revenue cycle management (RCM) is an area where confusion reigns.
Medical professionals submit millions of claims every day to payors. Most claims are reimbursed fully by payors. As per the AMA reports, claims denied on the first submission amount to 1.38% to 5.07% of the total claims.
A medical facility’s entire financial process is termed Healthcare Revenue Cycle Management (RCM) and it covers management and collection of revenue from healthcare service to patients.