Glossary, billing and revenue
What is revenue cycle management?
Revenue cycle management (RCM) is the whole process a healthcare provider runs to be paid for care, from booking and registration through coding, billing and claims to the final payment. It covers both what insurers pay and what patients pay themselves.
Updated . Defined by the wai team for clinics, groups and health systems.
Also called RCM or medical revenue cycle.
Why Revenue cycle management matters to a clinic
Money leaks at every hand-off. A missed appointment that is never rebooked, a code that does not match the note, a claim that comes back, an invoice nobody chases. Each one is small, and together they decide the margin of a clinic.
The cycle starts earlier than most clinics think. A clear price and cancellation policy at booking, a complete note on the day and an invoice raised against the visit each save work at the end.
Questions
Does RCM only apply to insured patients?
No. Self-pay clinics run a revenue cycle too, from the quoted price and the cancellation policy to the payment, the receipt and the reconciliation.
What is the most common leak?
It varies, but missed appointments that are never rebooked and claims that come back for correction are two of the largest in most clinics. See no-show rate.
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