Revenue Cycle

Management in
Healthcare

RS Presenter
 Claims Process Flow
Here’s a step-by-step flow of the back-end revenue cycle management process in
healthcare organizations:
08
Revenue Integrity
04
Denials
Management

02
Claims Transmission 06
Accounts Receivable (A/R)
Management

Claims Submission Claims Adjudication Payment Posting Patient Collections

01 03 05 07
 What is Revenue Cycle
Management?
RCM begins when a patient seeks the organization's medical services and ends
when the organization has collected all payments from the patient and/or their
insurer

1. Pre-
Registration
1. Patient 1. Registrati
Collection on
1. Codi 1. Registrati
ng on
1. Claim 1. 3rd Party
Follow-up
Submission
1. Charge 1. Utilization
Capture Review
Challenges Involved
Here are some challenges faced by Healthcare
Provider (Doctors, Nurses, Clinical Staff), Patient,
Administration Staff & Insurance Provider (Payers)
 High Rate of Claim
01 Denials

Errors in Coding
Challenges 02 and Billing
Involved

Healthcare Provider
Complex Insurance Verification and
03 Eligibility Checks

(Doctors, Nurses, Clinical Staff) 04

Inconsistent
Cash Flow

Challenges in Compliance and

05 Regulatory Changes
 Lack of Transparency in Financial
01 Responsibility

Challenges
Involved 02 Slow Payment Turnaround

Patient Patient Dissatisfaction and

03 Engagement Issues

Time-Consuming Collections
04 Process
 01 High Administrative Burden

Complex Insurance Verification

Challenges 02 and Eligibility Checks
Involved

Administration
Difficulty Managing Multiple
03 Payers and Contracts

Staff 04
Inadequate Denial Management
and Follow-Up

Limited Insights into Financial

05 Performance

Time-Consuming Collections
06 Process
 01 High Rate of Claim Denials

Challenges
Involved 02 Errors in Coding and Billing

Insurance Provider
03 Slow Payment Turnaround
(Payers)
Challenges in Compliance and
04 Regulatory Changes
 Feature Inclusions
Patient Financial
Counseling

Compliance
and Security

Analytics and
Patient Billing Business
Payment and Collections
Posting Intelligence

Integration
Capabilities

Claims
Management
Patient Revenue Analysis
Registration and Reporting
Automated
Billing System

Denial
Management
Appointment
Scheduling
 Streamlined Revenue
1 Generation
Centralized Patient
Billing Records 2

Benefits of Reduced Payment

Delays 3

Revenue Cycle 4
Automation of Routine

Management
Tasks
Enhanced Claim
Processing 5
Insight into Claim
6 Denials

Cost Savings 7

Data Analytics and

8 Goal Setting

Use of Advanced
Technologies 9
 Reduced Recurring Costs by
20% for Leading Eye-care
Chain with Custom EHR
About Client:

Acuity Eye, the largest chain of eye-care clinics in the USA, operates over 60 clinics across
California, providing top-tier patient care through a team of leading ophthalmologists and
optometrists.
Challenges: Impact:
• Disrupted workflows due to disparate EHR Developed Custom EHR System: Unified clinical
systems. workflows and documentation across all clinics.
• High costs from third-party EHR solutions and Implemented Robust Technical Architecture: Utilized
recurring expenses. Angular and PostgreSQL for scalability and
performance.
Solutions:
Seamless API Integration: Enabled efficient
• Developed Custom EHR System: Unified communication with insurance providers.
clinical workflows and documentation across
all clinics.
• Implemented Robust Technical Architecture:
Utilized Angular and PostgreSQL for scalability
and performance.
• Seamless API Integration: Enabled efficient
communication with insurance providers.
 Achieved 94-97% Triage
Accuracy with AI-Driven Mobile
App for Maya MD

About Client:
Maya MD is a US-based health-tech platform that leverages clinical AI insights to empower patients
and providers.
Challenges: Impact:
• Disrupted workflows due to disparate EHR Developed Custom EHR System: Unified clinical
systems. workflows and documentation across all clinics.
• High costs from third-party EHR solutions and Implemented Robust Technical Architecture: Utilized
recurring expenses. Angular and PostgreSQL for scalability and
performance.
Solutions:
Seamless API Integration: Enabled efficient
• Developed Custom EHR System: Unified communication with insurance providers.
clinical workflows and documentation across
all clinics.
• Implemented Robust Technical Architecture:
Utilized Angular and PostgreSQL for scalability
and performance.
• Seamless API Integration: Enabled efficient
communication with insurance providers.
Thank You