July 9, 2021

Tackling Revenue Cycle Management (RCM): A Guide for Independent Healthcare Providers

RCM, or revenue cycle management, are the systems designed to track how each medical patient’s office visit pays for itself and keeps the practice’s doors open. Independent healthcare providers want better ways to control the everyday routines that generate income. When practice management works well, staff members have more time and energy to focus on each patient who walks through their office doors. When systems misfire, both income, and patient relationships suffer from stress and neglect.


What is RCM?

RCM includes more than accounting; it covers communication between doctors, patients, staff, and health insurance networks. Visit authorizations, information intake, submitting health insurance claims, and responding to billing questions are all part of RCM.

Components of revenue cycle management, especially interpersonal communication, can be complicated. That’s why medical office workers go through extensive education and periodic retraining to keep up to date with regulatory and health insurance changes that affect the work they do. Because there are multiple steps involved in every part of the revenue cycle, errors may occur. Outsourcing companies like Advantrix provide the software and team member support to ensure coding, billing, and invoicing accuracy.


Why is the healthcare revenue cycle management complicated?

RCM begins even before the patient’s first office visit. Office staff first collect any required visit copay and then submit insurance information after the appointment ends. Staff document pre-authorizations, pre-certifications, and insurance network status, and check to ensure that insurance will cover the type of visit and services provided. And RCM continues after the appointment is over. Every office visit receives diagnosis and treatment codes. Staff submit claims to the patient’s insurance provider and invoice the patient for their share of costs. And when the patient returns for their next appointment, the cycle repeats itself. Thankfully for bookkeeping staff, accounting software links all of these successive visits to patient records. Items are tracked —  with notations stating how long they remain in accounts receivable and when medical invoices are closed, paid-in-full.

Common clerical errors typically delay health insurance claims payment and throw even the best-designed RCM plan out of whack. Advantrix identifies four complex problems that practice management notes about their approaches to RCM:

1.Medical billing and coding are challenging.

Professional medical billers need to keep up with frequent billing code changes — even a minor error can stall a payment. Staff needs to carve out time to repair the rejected claim and resubmit the bill to the insurance company before the payment window closes. Submitting incorrect codes results in delayed or unpaid reimbursements. These mistakes can add up and even lead the insurer to drop medical providers from their network. 

2.Patient-doctor relationships and communication are complicated.

Talking about medical bills can be tense. Having friendly professionals on hand who can have these conversations with patients takes the burden off doctors, allowing them to focus on patient care solely. A sound RCM system builds in many ways patients can communicate with billing staff and pay their share of office visit costs. 

3.Monitoring compliance and quality control aren’t easy.

Regulations and policies change quickly. Notices about new laws protecting healthcare privacy and access sometimes become muted background noise. Ensuring staff is aware of changes and the need to retrain or recertify is a vital aspect of RCM — insurance companies are continually evaluating how the providers in their network are meeting standards.

4.New changes in the office mean designing new roadmaps to revenue.

If health care providers band together and consolidate, accounting systems from separate offices need to merge. Bookkeepers and accounting staff need a roadmap to expand or integrate systems so that patient billing is organized and up to date even before moves, additions, and changes start happening.


Advantix can help fix complex RCM issues.

Outsourcing RCM to an expert solutions provider like Advantrix helps address the core issues that complicate RCM. Human errors tend to repeat themselves until something or someone steps in to untangle knotty problems.


How can Advantrix solve my medical practice’s revenue flow problems?

Advantix administers complete RCM resources for small independent healthcare practices. By outsourcing these tasks, your essential office staff has more time and energy to devote to patient care.

We have designed Opteli, our RCM software platform, to integrate all aspects of patient management for our customers. It’s a straightforward solution that we customize for any medical practice. Opteli’s RCM features help your practice management quickly visualize the financial health of your office. Dashboards display revenue flow and projections, and you can quickly drill down to see the activity, status, and history of any record.

Our IT support team is always available to help get you up and running, answer your questions, and train your team in interacting with Opteli and with members assigned to your account. Each subscriber owns all of their data and can download it from our secure servers as needed.

Advantrix aims to make processes simple for our small independent healthcare providers and solo practitioners. We believe our systems lift the administrative burden from medical professionals’ shoulders, giving them more time and energy to spend in patient healing.

We provide helpful, simple, and fast systems, allowing you and your team to work better, get more accomplished, and make smarter decisions in your healthcare workplace.


Improving revenue forecast health through a positive RCM experience.

When you partner with Advantix, you will find helpers to guide you through all the information you need to make the critical decision to outsource your RCM activity. A fully integrated, custom-designed software package supports all of the complicated back-end business tasks involved with running a medical practice: billing, payment tracking, and collections.

We will support your switch to Opteli, and one of our IT representatives will always be available to answer your questions. Feel free to get in touch with us, and our consultants will set an appointment at a convenient time for you.

We’re looking forward to speaking with you and learning about your goals for this year and beyond.


Photo credits: Photo by Bench Accounting on Unsplash