Revenue Cycle Management Compliance-How Policies and Procedures Provide a Solid and Effective Foundation

Abstract

Healthcare revenue cycle management (RCM) is the financial process facilities use to manage the administrative and clinical functions associated with claims processing, payment, and revenue generation and are an integral part of a healthcare organization's success. Effective RCM policies and procedures should cover all applicable aspects of the RCM process, for example: * RCM function * Guiding principles * Department organization * RCM committee * Key performance indicators * RCM code of conduct * RCM record retention * Patient scheduling * Patient registration * Insurance verification and patient eligibility * Preauthorization * Documentation of services * Charge capture * Medical coding * Claims generation and submission * Payment posting * Patient billing and collections * Accounts receivable follow-up * Denials management * Credit balances and overpayments * RCM monitoring and auditing Certain healthcare organizations will need additional policies to address the RCM function, and some organizations will only need a limited set; however, it is imperative that RCM policies address all aspects of the RCM function, including any outsourced RCM activities. What Is RCM Operational Compliance?_ The Revenue Cycle Compliance program (RCC) promotes compliance with applicable laws, regulations, and policies pertaining to billing and reimbursement of professional, hospital, and clinical research activities.