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What revenue cycle management means in a clinic
Revenue cycle management is a broad name for an unglamorous problem: the gap between the care a clinic delivered and the money it eventually receives for it. Most of that gap is created long before anyone submits anything.
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What the term covers
It covers everything that has to happen for a clinic to be paid: capturing who the patient is and how they are covered, recording what was done in a way that can be billed, sending that to whoever pays, and following up what comes back short or does not come back at all.
The last of those is where attention usually goes, and the first is where the money is usually lost.
The stages, in the order they fail
- Registration — a name spelled two ways, a stale coverage detail, a missing reference number. Cheap to fix at the desk, expensive to fix afterwards.
- Documentation — care that was delivered but not recorded in a form anyone can bill from.
- Submission — sending it to the payer, in whatever form that payer requires.
- Follow-up — the part that gets abandoned when the clinic is busy, which is when it matters most.
Which problems software can actually solve
Software is good at making information consistent, at making a piece of work visible so it is not forgotten, and at making it obvious when something has been sitting untouched.
It is not good at deciding who is accountable for chasing an unpaid item, or at making that person available. A clinic that adopts a system without deciding who owns the follow-up ends up with a well-organised list of things nobody is doing.
What to ask anyone offering to help
- Which stage are you proposing to work on, and how will we know whether it improved?
- Is this software, a service performed by people, or both — and which parts are which?
- What do you need from my team every week for this to work?
- Which payers, specifically, is this running with today?
Where SkyEagle sits, stated exactly
SkyEagle RCM is a separate SkyEagle product line. It is not part of SkyEagle HIS & EMR, and this article describes revenue cycle management in general rather than what that product does.
If this is the work you need help with, the product page sets out its scope, and we can walk you through the product against your own workflow and the stages above.
Where to go from here
Every SkyEagle product line can be seen in a walkthrough, with its scope and any configuration or integration requirements explained.