What to Look for in a Medical Revenue Cycle Management Firm

Medical revenue cycle is a fancy way of saying how long it takes for you, your office, or your hospital to get paid. The revenue cycle begins as soon as a potential patient calls your office to make an appointment. The cycle continues when the patient comes into the office and is treated. The patient is then billed. This is usually where the cycle stalls. Once a patient has had his or her medical condition treated, the incentive to pay has disappeared. The cycle is only considered complete once that patient’s bill balance reaches zero. To get that bill to zero, a medical revenue cycle management firm might be ideal. There are several management systems out there. Here are a few things you should look for.


Many firms send the bulk of their work overseas. This might save money for the management firms, but it can mean that managing your patients’ cycles can take significantly longer. Also, you do not know what quality of work you will be receiving. When it comes time to selecting a firm, you should look and see if the firm outsources. Even those that send their work to other companies within the same country are creating more steps for the work and slowing down the process. They are essentially middlemen. Why should you be paying them to send the work elsewhere? When you pick a firm, you should pick one that does all of its work in-house. That way you know exactly what you are getting, and you also know exactly who to hold responsible for good work or shoddy work.


The field of billing and coding is a very complex field that requires a professional to have very much knowledge in the medical field. The coder must have knowledge of diagnosis codes as well as medical procedure codes. Also, that coder must know about medical procedures because he or she has to assess the necessity of different medical procedures to determine the proper amount of billing. Only a licensed physician has the amount of knowledge necessary to accurately assess these situations.

Proprietary Technology

Some medical revenue cycle management firms use technology from other organizations. They buy software designed by some other organization. This is not ideal because there are no national or federal standards for coding and billing. So, how can a program designed in one state work as well in a different state? In short, it can’t. However, some organizations design their own proprietary technology that is adaptable to the ever-changing billing field. The rules and regulations are different in different parts of the United States. If a company has its own proprietary technology, it can easily change the parameters of a certain part of the program to better suit the needs of each customer or patient.

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