What are Revenue Cycle Management Software?

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Gartner defines revenue cycle management (RCM) software as healthcare financial software that tracks and captures revenue received from patients and healthcare payers related to an episode of care. The software combines the administrative and clinical aspects of healthcare delivery by coupling patient financial and clinical data required for reimbursement. The revenue cycle management process begins at the time of patient scheduling, and it includes the process of obtaining eligibility, prior authorization, billing and collections and ends with account reconciliation. This market definition includes offerings from enterprise RCM vendors and consists primarily of vendors selling stand-alone software solutions.
Healthcare delivery organizations (HDOs) use RCM software to streamline and automate their encounter-based financial workflows and billing processes. The software enables patient access, claims submission, accounts receivable (AR) management, and federal and state regulatory compliance. When implemented in conjunction with an electronic health record (EHR) system, RCM software unifies administrative and clinical data for HDOs. This results in enhanced patient engagement; higher staff utilization; enhanced financial planning; reduced fraud, waste and abuse; and improved revenue capture.

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What are Revenue Cycle Management Software?

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Optum Revenue Cycle Management

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