An Overview on Revenue Cycle Management (RCM)



Touseef Riaz

October 12, 2022

revenue cycle management definition

Everything You Need to Know About Revenue Cycle Management


When dealing with medical billing, have you ever felt you are doing well enough to increase your healthcare organization’s revenues? For most healthcare providers, dealing with medical billing procedures can be one of the most challenging tasks. For better management of medical billing tasks, outsourcing your medical billing needs is the most relevant and effective solution. 

The medical billing and coding industry is undergoing significant development, and changes are being made quickly. As a result, you can face severe consequences if you are inexperienced in handling medical billing operations. Moreover, revenue cycle management is the core factor of your healthcare organization, and dealing with medical coding and billing tasks simultaneously makes your job even more difficult. 

rcm revenue cycle management

Medical billing and coding companies like U Control billing have years of experience in medical billing and coding management. We are a reliable medical billing company. We effectively manage every single aspect of your medical billing and coding. Our core purpose is to enhance your profit margins and enable you to perform exceptionally well. After assigning us your medical billing and coding tasks, you can focus more confidently on patient care. 

Through advanced medical billing technology and qualified staff, we provide you with the best solutions to boost your revenues and streamline healthcare operations. In addition, our customer service team is highly active and competent in dealing with patients and handling their payment status. Ensuring high reimbursement rates and minimum claim denials is our main goal to strengthen your healthcare business. 

Outsourcing your medical billing and coding tasks reduces your in-house expenses. Your in-house billing staff needs office space to handle the billing process. However, when you outsource your medical billing and coding tasks, the team operates independently in their offices. 

One of the fundamental issues that different people face related to medical care is patient data breaches.  Healthcare organizations and patients are very curious about their personal data. Medical patient data contains very sensitive information, and it’s precious for patients. If your healthcare organization is involved in such a dreadful crime, you can be exposed to hefty fines and destroy your organizational reputation. 

U Control billing is HIPPA compliant and highly prioritizes patient data security. We are using intelligent software and technology to protect patient data from hackers. Patient satisfaction in every aspect of medical billing and coding is crucial for your healthcare business. We ensure that patients are delighted with your services and more likely to prefer you again in the future. 

Medical practices lose money every year due to claim denials. Incorporating an efficient EHR system reduces the probability of committing any errors that result in claim denials. Rejection of claims means you must spend more money and time to process those claims again for approval. It’s a hectic process, and you don’t want to face it. Medical billing companies ensure that every claim is approved without any hurdle and you receive maximum reimbursements. 

Innovative and intelligent medical billing software is vital for the smooth flow of medical tasks. Unfortunately, small or independent laboratories can’t handle the price of that software. Opting for our services removes the cost of purchasing expensive software, and your medical practices are conducted smoothly and efficiently.  

Medical coding revenue cycle management 

The healthcare business’s core aspect is prioritizing patient care and saving lives. However, without effective revenue management, these healthcare organizations can’t operate. In this aspect, medical coding and revenue cycle management plays a vital role. 

Medical coding and revenue cycle management deal with administrative and financial tasks of medical care organizations. These tasks are associated with patient registration, medical coding, claims to process, and generating revenues. Overall, it deals with every operational task of patient visits and provides unprecedented patient experience.  

If we look into the critical elements of medical coding revenue cycle management, it includes the following: 

  • Patient Pre-Authorization 

The patient undergoes a pre-authorization process before visiting the medical facility. In this process, insurance providers determine the type of medication to be provided to patients. 

  • Insurance Eligibility and Verification 

Medical billing software can easily monitor the insurance eligibility of patients. It’s crucial to verify the patient’s insurance eligibility before providing medical treatment. Afterward, you can acknowledge that the patient will have to pay for the provided services, or the expenses will be covered through insurance. 

  • Appropriate Coding 

Coding is the central aspect of claim reimbursement and smooth revenue cycle management. However, if your coding team isn’t effective enough to keep up with changing medical coding trends, you can lose revenue. 

Working with experienced coding staff who can adequately deal with coding stuff is critical for your healthcare organization’s revenue generation. 

  • Claim Submission 

It’s a vital stage where the medical billing and coding team should be active and experienced in filling in the claims information and submitting it to insurance providers. Effectively incorporating codes is the catalyst of claims approval. 

Accurate coding and an effective revenue cycle management process help to approve claims quickly and eliminate any possible claim denial errors. 

  • Denial Management 

In case the claims are rejected due to uncertainty, medical billing professionals instantly look into the matter and eliminate errors to proceed claim successfully. They ensure that you focus entirely on patient care, and medical billing professionals will handle the remaining aspects. 

  • Smooth Collections 

When the insurance payers process low reimbursements and all the patient services are not covered in the plan, medical billing and coding professionals must follow up with insurance companies and make required adjustments.

Overall, the role of Medical coding revenue cycle management is undeniable for healthcare providers. Clinics and hospitals can receive timely patient service payments by outsourcing their medical billing and coding tasks from U Control Billing. 

 Healthcare revenue cycle management is continuously evolving, and a qualified team is fundamental to keeping pace with these rapid changes. As a healthcare medical billing and coding specialist, getting aware of the latest medical billing and coding trends is essential to make reimbursement successful and receive timely payments. 

U Control billing is a renowned Medical Billing and Coding company that can effectively handle your Revenue Cycle Management process. We are working with the latest medical billing technology and a highly qualified team to manage your administrative and financial tasks. Contact us today for further assistance. 


Medical Claim Processing

Medical claim processing is among the core steps involved in medical billing and coding success. The stage of claim processing begins when the healthcare provider submits the claim request to insurance companies. 

In short, claim processing involves the approval of claim requests from insurance companies after checking claim information, authentication, and validity. After the claim is approved, the insurance company can reimburse the healthcare provider in whole or at different intervals. More importantly, insurance companies can reject your claim if it is found duplicated, invalid, or not adhering to policy terms. 

Let’s go through the different steps that are involved in claim processing: 

  • Claim adjudication 
  • Explanation of benefits (EOBs)
  • Settlement of claims 

In the process of claim adjudication, insurance companies examine the following elements:

  • Ensuring approval of pre-authorization 
  • Matching the claim details provided in the pre-authorization step. 
  • Patient eligibility for the claim 
  • Scanning duplication inside the claim 
  • Healthcare organization eligibility for claim approval 
  • Validity of diagnosis 
  • Was the treatment provided medically necessary?
  • Proper incorporation of medical codes for the treatment provided 
  • Validity of claim request amount

Insurance companies use a combination of different verification systems (automated and manual) to verify the authenticity of the claims. Afterward, the process of payment processing is done, and it is dependent on the insurance companies and how much they are willing to pay for the claim. 

When the process of claim settlement complies, the notification is sent to the hospital from the insurance companies. The notification contains information on either accepting or rejecting the claim. It’s mainly referred to as an explanation of benefits (EOB).

The details included in the EOB represents the following: 

  • Paid amount 
  • Approved amount 
  • Allowed amount 
  • Amount to be paid by the patient 
  • And so on

The final step involves claim settlement, where the insurance company pays the amount to the healthcare provider for the rendered medical services. The claim processing step involves extreme precision and accuracy for successful results. 

Outsourcing your claim management services from a renowned medical billing and coding company like U Control billing can be highly beneficial and valuable. We are a one-stop solution for handling your medical billing and coding tasks effectively. 

We are working with the latest technological medical billing system, which is effective enough to manage every aspect of the medical billing and coding process. Therefore, if you outsource claim management, you can have plenty of space for other critical medical tasks. In addition, it is cost-saving and can help you avoid administrative issues. 

Claim management is one of the crucial steps of medical billing. If you successfully generate maximum claims, patients are satisfied, and the revenue streams are consistent. On the other hand, failure to approve the claim process can disrupt the effort of claims generation and cost you big money. Therefore, a qualified team capable enough to deal with insurance companies and approve claims successfully is essential. 

We are working with a group of qualified medical billing and coding staff with years of professional experience in the medical billing industry. Our satisfied clients are proof of our authenticity and credibility. Outsource your medical claim processing from U Control billing and uplift your revenues. 

Medical Billing Issues

In the healthcare profession, we all face certain issues related to our specific tasks. The same goes for medical billing. These issues can relate to patient cooperation, claims, payment processing, etc. Common problems in medical billing include: 

  • Educating Patients 

Keeping your patients educated regarding medical billing is a gigantic task. When patients are accurately and efficiently informed about their medical billing details, they are more likely to proceed with payments. However, if your medical billing and coding team is ineffective, you may lose significant revenues. You can accomplish this task more effectively if you have optimized medical billing software. 

  • Timely Payments 

Timely payments are a big challenge that healthcare providers face from insurance companies and patients. However, if you outsource your medical billing services from U Control billing, smooth payment inflow is guaranteed. 

  • Effective Customer Support 

Customer support is precious in the medical billing profession. Your customer support team should be ready to face any uncertain challenge and provide instant solutions. In addition, if you provide quality customer support to the patients, they are more likely to visit your medical facility in the future. 

  • Claim Denials 

Medical billing and coding are subjected to multiple changes consistently, and staying on the right track is becoming hard. Medical codes are constantly changing, and the probability of committing mistakes in treatment coding is surging. 

Suppose you are using intelligent and updated medical billing software and a qualified medical coding team who has a keen eye on the coding changes. In that case, you can minimize claim denials dramatically. 

Claim denials can increase costs and eat revenues. Ensure to outsource your claim management from U Control billing to enjoy a 100 percent success rate in claim approval. Our team is competent and effective enough to deal with insurance companies and approve claims. 

  • Software 

You can disrupt your medical billing practice if you work with inappropriate medical billing software based on useless technology. As a healthcare provider, you should use smart and intelligent medical billing software to optimize your practice with negligible errors. 

U Control billing works with the latest technological medical billing software that can enable you to make smart and productive decisions and can easily manage your overall medical billing and coding process. 

  • Losing Revenues 

Healthcare providers’ most frustrating factor is losing revenues due to minor and avoidable errors. Additionally, if you are working with an incompetent team and manually handling medical billing tasks, you will likely face these issues in the future. However, you can eliminate these issues by outsourcing your medical billing and coding tasks from U Control billing. 

There are multiple medical billing issues, but the ones listed above are the most common. Now, outsourcing your medical billing and coding tasks has become common practice to enhance the Revenue Cycle Management process. If you are a healthcare provider, contact us today to simplify your Medical billing and coding process. 


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