Revenue cycle management (RCM) is the process that  a health care provider uses to track patient service revenue from the time of account creation to the final payment. In other words, it refers to all the administrative actions and tasks that constitute the capture, management, and collection of treatment expenses incurred on a credit patient by the healthcare provider.

Based on the size and scale of operations of the facility, RCM can be managed inhouse or outsourced. When the scale operations are increased by way of increased patient footfall from insurance sector, empanelment of multiple government schemes and tie-up with direct corporates etc., it makes sense to outsource the RCM services to Professional teams. This will save the healthcare provider much time, energy and resources in credit services operations, processing of claims and following up of payments from credit parties.   

The Scope of Revenue Cycle Management include end-to-end credit management of Health Insurance, Government Health Schemes such as ESI, ECHS, KASP, MEDISEP,  Ayushman Bharath etc. and other Direct Corporate Tie-ups like BPCL, IOCL, HPCL, ONGC, Cochin Shipyard, Apollo Tyres etc.
The RCM process begins with receiving the of patients → Insurance Counselling & Eligibility Verification → Treatment → Budgeting Preauthorisation management including processing of initial cashless approval, query management (if any), Interim bill enhancement approval and collection of advances (if any) → final approval management during discharge → Collection of Co-pay, Non- Medical Expenses, Difference Amount → Patient Settlement → Database Management → Claim Docket Preparation and uploading to Payer Portal → Hardcopy Submission with respective payers → Query Management (if any) → Payment follow up → Payment reconciliation → Settlement of account → Resettlement of Short payment (if any) → MIS Reports → Audit Management.

The key objective of RCM is to ensure STRONG BOTTOM LINE BUSINESS. Bringing in an expert team will help the Healthcare Organisation to focus on their primary objective of patient care.  A professional RCM team will help in faster recovery of pay-out from payers, reducing revenue leakages, collection of patient payables with accuracy, lesser grievances from patients due to delay in insurance approval processing etc .

• Patient Centric approach and increased patient experience
• Better Payer Relationship
• Reduced Days of Outstanding
• Increment in Business volume- both in numbers and revenue
• Control on Revenue Leakages
• 100% Adherence to the tariff and MOU terms and Conditions agreed with the payers
• Better management of Internal and External finance audit
• 100% Adherence to MIS Reporting etc.