Revenue Cycle Management in Healthcare Explained

Revenue Cycle Management (RCM) in Healthcare Explained.
Revenue Cycle Management means 'getting the bills paid' for hospitals, doctors and other healthcare providers.
The video explains the steps in RCM: 1) Pre-Registration, 2) Registration, 3) Charge Capture, 4) Utilization Review, 5) Coding, 6) Claim Submission, 7) Remittance Processing, 8) Follow Up and 9) Patient Collections.
RCM is a $29B a year industry and Becker's Hospital Review has a list of 354 healthcare RCM companies in America.
Accordingly, the RCM industry is highly fragmented meaning 1) there are low barriers-to-entry for starting an RCM company and 2) the competence/performance of RCM companies is highly variable.
RCM effectiveness is measured in Accounts Receivable (AR) Days. Hospital AR Days range from 30 to 70, which for a $3B per year hospital system is a difference of $328M in cashflow.
RCM is so complicated that many physicians are selling their practices to hospital systems so that the hospital can take over the RCM and do a better job with it.
Related AHealthcareZ Videos:
Utilization Review: • Utilization Management...
Medical Coding: • Medical Coding Overview
Sources:
www.futurewiseresearch.com/he...
www.beckershospitalreview.com...
revcycleintelligence.com/feat...
blog.pmmconline.com/blog/reve...
www.amnhealthcare.com/amn-ins...
www.marketplacer.com/blog/how...
www.medisysdata.com/blog/calc....

[@user-wl2oh4sr3n]

I am a GI fellow who is extremely passionate about simply understanding the business that I work for. This video has been one of the most informative videos I have ever seen on youtube. 99% of doctors do not know what a RCM is and have no idea how a hospital makes money. Thank you so much for sharing this insight! Definitely subscribed and taking notes on your videos!

[@ahealthcarez]

Super! Thank you for watching.

[@rufussweeneymd]

Psych intern here. Same feelings. Glad I’m not alone in puzzling through this stuff.

[@OlufunshiAyo]

I am currently taking my MBA in Healthcare management and this video is golden!! We discussed about the revenue cycle in one of my classes. This just made me understand it more... I love Healthcare!!!

[@ahealthcarez]

Thank you for watching and for your feedback.

[@colleenwrites]

Thank you for sharing your experience. This is another example of why hiring people passionate in their work is crucial. Revenue Cycle Management is truly a song that never ends between Provider and Payer.

[@ahealthcarez]

Thank you for watching and sharing your thoughts.

[@vitalhealth4203]

I'm working in US Healthcare company from India... It is the one of the most important questions when interviewer asked questions in interview... You made it understand very clearly.. Thank you... We want more videos regarding denials and healthcare knowledge 😊

[@ahealthcarez]

Super. Thank you for watching.

[@SteveSchutzer]

Another fabulous episode by Dr Bricker. I did have to chuckle a bit and marvel at the ridiculous complexity of RCM. I am co-founder of a healthcare startup. We get paid by a BUCHAH TPA for services to one of our clients. We get paid by a "case rate" for a bundle of services. We have only ONE code and ONE case rate (that's it) and yet the insurance company cannot get it right - and our days in AR keep growing. One code and one reimbursement! Is this by accident I ask?

[@ahealthcarez]

Good question. No. So frustrating. Thank you for watching.

[@OneTwo-jv8oq]

Thank you for your commitment, sharing your knowledge and talents, to help us all better understand allocation of 4.5 trillion dollars annually!

[@ahealthcarez]

Thank YOU for watching.

[@changyang6775]

Excellent story of the RCM, especially the comments you made! I hope more physicians could be powered by these knowledges and ethics you have.

[@ahealthcarez]

Thank you for your feedback.

[@fhd89234n8f43n7]

Amazing video and so clearly explained!! I want to meet this guy sometime.

[@ahealthcarez]

Keep your expectations low. 😉 Thank you for watching.

[@user-hx8lt9fk9d]

Excellent! Absolutely brilliant presentation!

[@ahealthcarez]

Thank you for your support.

[@akshayshekhawat1615]

Thanks! This was really informative

[@ahealthcarez]

Thank you for your comment.

[@nathanmartinez8864]

Thanks for this and if you ever want to go into even more details about the out of network claims process and or the journey of the automation of claims submissing from EHR-Clearinghouse would love to talk! Great job again!

[@ahealthcarez]

Thank you for your support.

[@albertjstanley]

This was a super insightful video for me, as I'm very new to this field. I was wondering what you've seen being done to speed up the very manual claim submission process you described? It struck out to me as a place where generative AI could automate the process of responding to denied and delayed claims (perhaps using Large Language Models to generate automated responses whether online or over the phone). I would imagine that helping automate these processes could reduce the accounts receivable days. Thanks so much for the content! Came at just the right time.

[@ahealthcarez]

Yes. Many groups are working on that.

[@SpecialK711]

Excellent summary of an unnecessarily complicated process that has, in fact, become increasingly costly & burdensome in the past 30 yrs. I can't blame physicians one bit for deferring this administrative mess to a hospital group, but the flip side is that they also relinquish a disparate share of their autonomy. This can only change in their favor @ the legislative level.

[@ahealthcarez]

Thank you for sharing your perspective.

[@kdowning79]

As long as the insurance company lobbyists have control through regulatory capture of the legislative process, physicians will always be at a disadvantage and stymied progress will remain steadfast.

[@somarble]

It would be interesting to see this ecosystem map of interactions between providers, payers, and other entities involved.

[@ahealthcarez]

Thank you for your suggestion.

[@somarble]

@@ahealthcarez seems like there are many players yet making things more complicated and error-prone rather than helping providers get paid

[@otiliapopescu9264]

How would you optimise this cycle?

[@ahealthcarez]

Great question.

[@asdfaam]

What product would you like to see in RCM that would solve a lot of problems

[@ahealthcarez]

Good question. It’s not a product, but rather a financial relationship… Providers going at risk and collecting a constant stream capitated payments. I.e. Not fee-for-service.

[@asdfaam]

​@@ahealthcarez what's stopping this from happening?

[@Nerr006]

​@@asdfaam it's a big leap for the ops teams to transition from fee-for-service to capitation and difficult to manage both models simultaneously. Totally agree that capitation makes the most sense for providers and assists with resolving some of the cashflow challenges.