Revenue Cycle Management (RCM) steps
Revenue Cycle Management (RCM) tracks revenue from a patient’s first contact through final payment, making sure services are documented, coded, billed, and collected efficiently while minimizing rejections and denials.
14 steps
RCM flowchart
The full cycle from appointment to denial management. Tap any step to jump to its details.
- 1Appointment Scheduling
- 2Eligibility & Benefits Verification
- 3Registration & Pre-Encounter
- 4Encounter (Service Delivery)
- 5Medical Transcription
- 6Medical Coding
- 7Demographic & Charge Entry
- 8Claim Submission
- 9Scrubber
- 10Clearing House & Payer Rejection Screening
- 11Insurance (Payer Processing)
- 12Payment Posting
- 13Accounts Receivable (AR) Follow-Up
- 14Denial Management
Steps of RCM
Front end: before the visit Steps 1–3
1Appointment Scheduling
- Patient books appointment via call or online.
- Helps manage provider availability and avoid wait times.
2Eligibility & Benefits Verification
- Verify patient’s insurance eligibility and covered benefits.
- Confirm via payer websites or patient’s insurance card.
- Essential even for returning patients (policy may change).
3Registration & Pre-Encounter
- Collect patient documentation, consent, financial responsibility forms.
- Obtain any required authorizations, ensure availability of instruments / reports before service.
Service and coding Steps 4–6
4Encounter (Service Delivery)
- Provide the actual clinical services.
- Record details (via dictation, notes) for later use in documentation and coding.
5Medical Transcription
- Convert voice dictation or recorded notes into formal medical records.
- Ensures accurate written record for coding and billing.
Billing and submission Steps 7–10
7Demographic & Charge Entry
- Enter patient demographics and coded charges into a Practice Management System (PMS).
- Accuracy is critical to avoid clearinghouse or payer rejections.
8Claim Submission
- Send claims to payer using forms (CMS-1500 for physician claims, UB-04 for hospital claims).
- Claims include all required provider, patient, and service details.
9PMS Scrubber / System Scrubber
- Automated validation of formatting and field rules before claim leaves the system.
- Detects errors (e.g. invalid number formats) for correction before submission.
10Clearing House & Payer Rejection Screening
- Clearinghouse validates and may reject claims before passing to payer.
- Then payer runs its own checks — claims may be rejected due to eligibility, provider enrollment, payer ID, etc.
Payer, payment and follow-up Steps 11–14
11Insurance (Payer Processing)
- If accepted, insurer reviews claim and issues either payment or denial.
- Generates EOB (Explanation of Benefits) or ERA (Electronic Remittance Advice) documents.
12Payment Posting
- Provider posts payment or denial details from EOB/ERA into system.
- If EOB/ERA not received, team may retrieve via payer website.
13Accounts Receivable (AR) Follow-Up
- AR team investigates missing or unclear payments.
- Contact payer to clarify or recover outstanding amounts.
14Denial Management
- Analyze claims denied or partially paid and identify reasons.
- Take corrective actions: resubmit, appeal, correct coding or provider enrollment, etc.
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Accurate coding and clean charge entry reduce rejection and denial risk, and speed up reimbursement.
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