Revenue Cycle Management

Revenue Cycle Management is the process of collecting payment for medical services, whether from insurance companies, HMOs, Medicare and Medicaid, or patients (also known as "self-pay"). The process generally begins at (or event before) admission to a hospital, or upon arrival at a physician's office. Healthcare providers often employ collection agencies to act as "first parties," assisting patients with the process of understanding their bills and identifying payment sources or applying for charity care. After a certain period of delinquency, some healthcare providers will employ "third party" collection agencies to recover unpaid balances on a contingency basis.

Revenue Cycle Resources

Best Practices for Resolution of Medical Accounts: A Report from the Medical Debt Collection Task Force - This document is based on the deliberations of the Medical Debt Collection Task Force, a joint initiative of ACA International and the Healthcare Financial Management Association. Published in January 2014, the report reflects the task force's consensus on the current state of best practices related to the equitable resolution of the patient portion of medical bills.


CFPB Report on Credit Reporting Impact of Medical Debts - In December 2014, the Consumer Financial Protection Bureau Director called on credit reporting agencies to take a more active role in policing the companies that furnish data on consumers, including a mandate to report consumer disputes made against specific companies. The new requirements stem from this CFPB study on debt collection tradelines in credit reporting.


U.S. Department of Health HIPAA Information page - An information repository on the Health Information Portability and Accountability Act (HIPAA) from Health and Human Services, the federal agency that administers the law, including the HIPAA Privacy Rule and the HIPAA Security Rule.


U.S. Centers for Medicare & Medicaid Services – ICD-10 - ICD-10 is the global medical coding standard for classifying diagnoses and reasons for visits in the healthcare setting. It is administered in the U.S. by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS).


2015 Medicare Physician Fee Schedule - The MPFS lists the more than 7,400 unique covered services and their payment rates to physicians in the U.S.


Seven Crucial Compliance Conversations for Every Hospital CFO


Three Strategies to Shrink Bad Debt: Presumptive Charity Care, Propensity to Pay and Partner Management


Whitepaper: The Perfect Medical Bill, Paid Perfectly - This paper sets a general framework for the discussion your organization needs to have to in order to identify weaknesses across your receivables operations, and choose a course of action to collect more cash, quickly.


Whitepaper: Using New Technology to Meet the Challenges of Reducing Healthcare Bad Debt - There has never been a more critical time for US healthcare providers to ensure they follow guidelines of best practice when it comes to billing and payment.


[SLIDE PRESENTATION] Healthcare Debt Sales: Tips to Boost Revenue and Effectively Manage Patient Relationships - Selling medical debt can be a smart option that many hospitals overlook when thinking about how to manage their revenue cycle most effectively.