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What Is Revenue Cycle Management In Healthcare

The healthcare industry is essential, providing patients with necessary and sometimes life-saving health services. As important as healthcare is, healthcare organizations are still charged with ensuring that they can operate consistently in order to provide these frequently necessary and often life-saving services. A major consideration for many healthcare organizations is ensuring that cash flow sufficiently enables them to operate. In order to accomplish this, healthcare organizations may rely on revenue cycle management in healthcare or RCM.

But what is revenue cycle management in healthcare? 

This is the process by which healthcare organizations manage their revenue which takes a systematic approach that considers the revenue cycle. So, what is the revenue cycle? Why is it important to healthcare organizations? The revenue cycle is the process through which healthcare organizations generate revenue. 

This includes, for example, patient scheduling, pre-registration, charge capture, claims submission, and collections. These steps comprise the process that healthcare organizations must carry out in order to generate revenue. 

Though the process of revenue cycle management can be broken down into a handful of general steps, each individual step can be complex—and contain individual steps of its own. Healthcare organizations must contend with challenges associated with billing, collections, health insurance claims, and much more. It can be a complex process, and that’s where healthcare revenue cycle companies come in. 

Revenue cycle management in healthcare is vitally important. This enables healthcare organizations to continue operations, remain compliant with relevant regulations, offer high-quality care to patients, and avoid funding deficiencies that could burden patients or put their ability to offer patients care at risk. 

In order to meet the needs of healthcare organizations in RCM, revenue cycle companies offer solutions aimed at enabling robust revenue cycle management. They can do this through various means, such as providing software solutions and even hardware that better enables healthcare organizations to manage their revenue cycle. 

Top RCM companies offer healthcare organizations services and tools that enable them to manage their revenue cycle more efficiently. This can be highly important, as revenue generation in healthcare organizations can be highly complex and consists of several steps. For example, healthcare organizations must often navigate the insurance world and contend with the claims process. 

RCM is an important consideration, often crucial to healthcare organizations’ success and continued operation. As such, organizations must often prioritize their efforts in managing revenue cycles. Revenue cycle management companies offer support to healthcare organizations in managing this crucial process. 

If you’re interested in learning more about revenue cycle management, read on. We’ll be exploring what revenue management companies can do, the steps in the revenue cycle for many healthcare organizations, what revenue cycle management is in the context of medical billing, and what the revenue cycle is in healthcare. 

Revenue Cycle Management Companies

Revenue cycle management is important for many healthcare organizations. As we’ve discussed, this crucial process enables healthcare organizations to operate efficiently and avoid funding deficiencies that could potentially lead to serious troubles–such as an inability to operate, a financial burden placed on patients, and even noncompliance with important, relevant regulations or laws. 

These potential adverse outcomes can be devastating to healthcare organizations and the patients who rely on them for necessary medical services. 

As such, many healthcare organizations must focus significant efforts on ensuring that revenue cycles are managed sufficiently to avoid these and other negative potential outcomes. 

In order to meet these needs, revenue management companies offer support to healthcare organizations in managing revenue cycles. Healthcare companies can seek support in various ways when it comes to revenue cycle management. 

For example, healthcare revenue cycle management companies may aid healthcare organizations in managing and overseeing administrative tasks that are related to the revenue cycle. RCM companies can help healthcare organizations with things such as billing and coding, collecting payments, and more.

RCM companies also may help healthcare organizations implement important technology that can help them manage revenue cycles. Some might consider RCM companies that are able to offer the most comprehensive services to be top RCM companies. In USA-based healthcare organizations, compliance with United States laws can be a particularly important consideration in revenue cycle management. 

As such, RCM companies that can help healthcare organizations ensure they remain compliant with relevant regulations and laws can be beneficial to healthcare organizations. 

In any event, which RCM company is the best fit for a particular healthcare organization can depend on a range of factors–including the needs of the organization, the organization’s budget, and the expertise, track record, and capabilities of the RCM company in question. 

Revenue Cycle Management Steps

There are many important steps in the revenue cycle for healthcare organizations. Different organizations may use processes that vary throughout the revenue cycle, but there are some common steps we can explore that are common among healthcare organizations. 

The number of steps can vary depending on how these processes are carried out, the healthcare organization in question, and other factors. 

In some cases, revenue cycle management can be broken down into ten general steps, but in other cases, there may be 13 steps of revenue cycle management. Though revenue cycle management steps can vary between organizations, and some may consider multiple steps one step or vice versa, we can look at some common stages in a revenue cycle. So what are the six stages of the revenue cycle? We can break those down as follows:

  • Patient scheduling
  • Pre-registration
  • Charge capture
  • Coding 
  • Claims Submission
  • Collections

Additionally, organizations may need to take additional steps, such as ensuring medical necessity or managing denied claims, creating additional steps in the process. Though the number of individual steps can vary between healthcare organizations, many common steps must be carried out in order for a healthcare organization to generate revenue sufficient to maintain operations, avoid potential legal woes associated with legal noncompliance, and ensure that they’re able to offer patients a high level of care without putting an unnecessary financial burden on them. As such, it can be important to understand the basic steps in revenue cycle management. 

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What is Revenue Cycle Management in Medical Billing

Teams in healthcare organizations tasked with billing fit firmly within the realm of revenue cycle management. As billing is an essential step in generating revenue for healthcare organizations, it’s an important part of the RCM process. Revenue cycle management in medical billing is essential for ensuring that healthcare organizations are able to collect the payments they are owed for the services they provide. 

This helps not only ensure that the organization is able to stay financially healthy but that the organization is able to provide high-quality medical services to the patients who rely on it. Unfortunately, should healthcare organizations become unable to operate, many patients can be affected as a result. These are just a few of the many reasons that robust revenue cycle management is important and why revenue management companies can be a significant aid to healthcare organizations. 

So what is revenue cycle management in medical billing? Which steps do RCM teams take to help ensure that the organization is able to generate revenue and continue operating? Significantly, RCM teams may help with everything from patient scheduling to charge capture. These critical steps help ensure that healthcare organizations can receive payments for the services they provide to patients. 

As many healthcare organizations rely on funding from services covered by insurance, this process can be as crucial as it is complex. It can be vitally important to have a well-managed revenue cycle, wherein everything from patient scheduling and pre-registration to collections and claims processing is carried out carefully and transparently. 

What is the Revenue Cycle in Healthcare

We’ve explored quite a bit of the revenue cycle in healthcare. We’ve discussed how the revenue cycle is the process by which healthcare organizations are able to generate revenue and how it consists of many steps–each with its own complexities and importance. The revenue cycle process is essential to healthcare organizations, as it would be impossible for many to operate without revenue. 

Revenue cycle management is the process of managing this cycle and ensuring that healthcare organizations are able to effectively receive the payments they need for the services they render. A well-managed revenue cycle in healthcare isn’t just important for the organization’s bottom line, however. It also is often vital for creating a fair and transparent process that patients can trust. 

Understanding exactly what the revenue cycle in healthcare is can be important for teams working in this important process. Revenue cycle management training modules, classes, and courses can help familiarize relevant team members with this crucial process. What’s more, healthcare organizations can, and often do, seek the services of RCM companies that offer assistance in RCM. Revenue cycle software and other tools can help enable organizations to carry out efficient revenue cycle management and stay on top of essential considerations. 

By better understanding this important process and ensuring that each step is carried out carefully and adequately, organizations can better posture themselves for long-term success and continued operations. 

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