6 Best Practices for Revenue Cycle Management Success

Revenue cycle management (RCM) is critical for practice’s success, as most healthcare practices today hardly cope up economically. Increased supervision and reward-for-performance models, along with declining reimbursements are causing many practices to lose profitability.

As per the research, most practices lose up to 30% of their potential revenue every year due to few glitches, this can be taken care by adapting certain RCM practices which will eliminate the obstacles that hinder the revenue earned. Here a few list of best practices which can be utilized to optimize collection and improve revenue cycle.


Denials should be prevented as it is leading to increased expenses and a lot of debt. Practices now need to find a productive way to manage denial volume and successfully appeal claims for the conclusion. Failing to appropriately manage denials from Insurance results in lost revenue and can impact a practice’s ability to bolster financial burden. A claim can be denied due to various reasons. But when a claim is denied, a lot of time and money is consumed just to follow-up.

Indeed, a large percentage of denials are not even addressed. A strategy should be devised to resolve the denials and for that first step would be to identify the reason for denial. Few common data errors that can result in a denied claim and loss of payment can be corrected by using astute claims editing before the claim is submitted Or a Software can help, expEDIum Medical Billing Software implement such rules time to time so that solution reported such issues on claims before claims being submitted to Insurance.  Also, immediate investigation of such claims and underpaid claims is needed for an active practice.


It is important to examine the active RCM workflow and look out for what is lacking, what the efficiency is and dispose of the waste in the workflow to see how it benefits them. This would help in analyzing how the practices can reinforce their current workflow. So, instead of jumping into replacing their revenue cycle management workflow, they should take a proper look at what they already have and decide whether an entire renewal is required. To verify the effectiveness of your workflow needs data. Make sure you have such data handy or such data can be extracted from your RCM software.


Regular submission of claims is fundamental for the regular cash flow of your practice. Not only it will make sure that claims do not become uncontrollable, also holding on to this practice harbors detail-aligned processing and submission.


To boost the revenue-generating capacity of the practice, a thorough analysis of the financial capability of the patients should be conducted. While scheduling an appointment of the patients, if financial clearance is conducted, it will confirm insurance coverage, eligibility for the services, benefits, and financial responsibility.

You should also have the staff to call patients with outstanding balances and keep an appropriate system to determine the patient’s balance and due. Collecting payments up front at the time of service would be the most effective way to increase a practice’s cash flow and save cost.


A routine coding review will assure that coding practice is up to date and it aligns with current guidelines. Further, it makes sure that your practice is not rejected due to outdated codes.

Employing experienced coder can offer profit to your practice. Also, monthly Reporting should be practiced regularly. This will let you have a good level of transparency in your practice finances. These few areas can significantly enhance the financial health of the practices if implemented with patience and dedication.


Accounts receivable follow up to keep at AR minimum is critical to RCM success. An effective A/R management would help the practice to recover more than 60%-70% of your denied claim, which highly enhances your financial performance. expEDIum RCM always keeps AR at almost 0% at any given point of time by its billers.

Make sure that your claims aren’t aged, every unpaid claim needs a healthy follow-up and addressing the delays at a specific period. The Billing software you use should help you keep a detailed track of the claims being unpaid, thus by providing appropriate reports and summary which specifies the age or the number of days the claims being unpaid. A biller should know the status of every claim he/she submitted.