Revenue cycle management (RCM) is the full financial process behind a medical claim — everything that has to happen for a practice to get paid correctly and quickly for the care it delivers.
What are the stages of the revenue cycle?
- Patient registration & eligibility: capturing accurate demographics and verifying insurance coverage and benefits.
- Prior authorization: securing approval for services that require it.
- Charge capture & coding: translating the visit into accurate ICD-10, CPT, and HCPCS codes.
- Claim submission: scrubbing and sending clean claims to payers.
- Payment posting: recording payments, ERAs, and EOBs accurately.
- Denial management & appeals: correcting and appealing denied or underpaid claims.
- A/R follow-up & patient billing: pursuing outstanding balances until resolved.
- Reporting: measuring defined indicators and identifying where workflow or payment follow-up needs review.
Why does RCM matter?
Every stage creates a handoff, decision, or exception that needs an owner. Missing information, unresolved authorization status, unsupported coding, submission errors, posting variances, and unworked follow-up can delay or prevent appropriate payment.
In-house vs. outsourced RCM
Practices may keep RCM in house, outsource selected workflows, or use a fuller external operating model. The right comparison should normalize scope, staffing, systems, controls, reporting, implementation, total cost, data rights, and transition support.
Revyn supports revenue-cycle workflows for practices nationwide, with scope, ownership, implementation, reporting, and applicable evidence defined for each engagement.