RCM Overview

RCM is the financial process, utilizing medical billing software that healthcare facilities uses to track patient care episodes from registration and appointment scheduling to final settlement of doctor visits

RCM unifies the business and clinical sides of healthcare by coupling administrative data such as patient's name, insurance provider & other personal information with the treatment patients receive and their healthcare data.

Communicating with health insurance companies is a key component of RCM industry. When a patient schedules an appointment, the physician's office &/or the hospital staff typically check the patient's reported insurance coverage before the visit. After an insured patient receives treatment for a given condition and supplies any applicable copayment, a healthcare provider or medical coder categorizes the nature of the treatment according to ICD-10 codes. The hospital or care facility then sends the care summary with ICD and Current Procedural Technology codes to the patient's insurance company to see what portion of the care will be covered by insurance, with the patient billed for the remainder.