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Revenue Cycle Management (RCM) refers to the financial process used by facilities for managing clinical and administrative procedures related to revenue generation, payment, and claims processing. It is essential for healthcare organizations to develop and implement efficient policies supporting the financial stability of the company (Jewell, 2020). As a rule, healthcare RCM comprises front-end and back-end components, with each including its own departments, policies, and staff. While the former involves patient-facing processes, such as registration, scheduling, authorization, eligibility checks, and upfront patient collections, the latter deals with claims management, compensation, and medical billing (Jewell, 2020). Due to the increasingly rigorous regulations for payers, the back-end process of Revenue Cycle Management is vital since it can offer solutions for insurance providers aiming to eliminate penalties.
The starting point of Revenue Cycle Management is the moment when a patient arranges an appointment, and the pre-registration process occurs, including creating a patient account with insurance coverages and medical histories. In the next stage, collecting accurate data through patient registration and scheduling is critical. The back-end revenue cycle begins once providers complete coding responsibilities and clinical documentation processes (Jewell, 2020). This process implies that claims must be created and submitted for reimbursement to the payer. Further steps include the medical billing procedure and the collection of patient financial responsibility. RCM staff engages in a variety of processes as part of the back-end operations, which emphasizes the importance of these procedures and their efficiency to the entire cycle management within an organization.
As can be seen, it is essential to discuss the aspects of the backside revenue cycle in healthcare and explore its role in organizations. According to Research and Markets (2020), the global back-end RCM market is anticipated to “reach $12.74 billion by 2026, growing at a CAGR of 7.0% from 2019 to 2026” (para. 2). A report by Research and Markets (2020) claims that such a market growth can be attributed to the following factors: “the rising significance of refutation management, declining reimbursement rates, and increasing patient volume” (para. 3). At the same time, high deployment cost hinders the back-end RCM market growth. With this tendency in mind, the importance of back-end Revenue Cycle Management for both the health care organization and the insurance provider can be observed.
In this regard, insurers must comply with a number of federal and regional regulations and laws in relation to security and privacy concerns, patient data, as well as reporting and auditing requirements. Back-end RCM includes collecting and managing revenue from the back-end office and implies numerous responsibilities and roles of the staff involved (Jewell, 2020). The solutions offered by backside revenue cycle procedures can ensure the adherence of insurance providers to regulatory requirements, which would eliminate redundant penalties and punishments (Research and Markets, 2020). Collaboration between the front and back-end RCM can increase patient collections and contribute to the efficiency of the process.
To conclude, healthcare Revenue Cycle Management refers to a complex process controlling the flow of revenue throughout the organization. The growing number of regulations about safety and patient data emphasize the importance of back-end RCM as a means of eliminating unnecessary expenses and penalties. The collaboration of staff from the front and back ends is vital to ensure the smooth flow of revenue and the efficiency of the processes to all parties involved.
References
Jewell, B. (2020). Revenue Cycle Management. In N. Baum & M. Kahn (Eds.), The Business Basics of Building and Managing a Healthcare Practice (pp. 19-29). Springer, Cham.
Research and Markets. (2020). Worldwide back-end Revenue Cycle Management industry to 2026 – by delivery mode, product & service, end-user and geography. Intrado. Web.
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