Revenue Cycle Management
- Operation

Along with RCM system, equally important to have an experienced medical coders and other supporting RCM operational resources for effective RCM outcome.

Hospital requires qualified resources to successfully navigate the RCM process, a great deal of training is required to ensure compliancy. However, given the high volume demands of the billing process, finding the time for proper training and right resources can be a challenge – not to mention expensive. Many hospitals consequently struggle to ensure that their RCM department receives the instruction, support and resources to function efficiently and accurately.

Cephal offers RCM professionals who are qualified medical coders and experienced in RCM process

Specialized resources are required for following process

Pre-authorization and eligibility verification

When a patient makes an appointment, the healthcare provider collects information to establish a patient insurance eligibility.

Charge capturing and Medical coding

Charge capturing is the process by which patient services are transcribed into billable charges using universally accepted medical codes. These codes are how insurers determine reimbursement amounts. Without proper medical coding, the insurance company may deny the patient’s claim. This results in delayed provider reimbursement.

Claims submission

Once a patient’s treatment has been properly coded and audited, the claim is sent to the insurance company for approval. RCM ensures this submission happens quickly by tracking and managing the claim from the start of the process.

Payment collections

Once the patient’s claim has been approved, the insurance company reimburses the provider based on the patient’s eligibility.

Medical service review

Thorough revenue cycle management encourages care providers to analyze clinical treatment data. Analyzing this data allows providers to pinpoint steps in the cycle where errors are being made and identify ways to lower their expenses. In turn, this will help increase provider revenue and improve the patient experience.


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