Revenue cycle management as defined by the Health Care Financial Management Association (HFMA) is “all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.”
RCM essentially comprises the entire life cycle of a patient account from registration to claims processing to payments, denials, and appeals.
The challenges around charge capture, clean claims generation, follow-up on denials, and securing payment for resolution of claims is perhaps the most complex and tedious, yet exciting, paradox of a health care organization’s financial health.