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How the revenue cycle works

Our RCM Process

See how the revenue cycle works, from the coverage check before each visit to payment posting and reporting, and how MedixCode runs each stage inside the EHR/PM system you already use.

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  • HIPAA compliant
  • AAPC/CPC Certified Coders and Billers
  • Works inside your existing EHR/PM system

What Is the RCM Process?

The RCM process is the series of steps a practice follows to get paid for patient care. It starts with checking coverage before the visit, moves through coding, claim submission and payment posting, and ends with following up on denials and unpaid balances and reporting on the results.

Each stage depends on the one before it, so an early miss, like an unchecked benefit or a code that doesn't match the note, comes back later as a denial. Below is how each stage works and how MedixCode runs it.

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  1. Step 1 Coverage, benefits and authorizations checked before care
  2. Step 2 Charges and codes matched to the documentation
  3. Step 3 Claims scrubbed, then submitted through a clearinghouse
  4. Step 4 Payments posted, denials worked, balances followed up
  5. Step 5 Results reported and fixes fed back upstream

Before the First Claim

A few things are settled before your first claim goes out.

Discovery

We start with a free consultation about your payer mix, your open claims and how your billing runs today.

Onboarding

We agree an onboarding timeline after reviewing your systems, data access and payer requirements. If a provider still needs payer enrollment, we offer credentialing as its own service.

Workflow Setup

We set up your workflow inside your own EHR/PM system, so there's no new software for your staff to learn.

Revenue Cycle Management Process Steps, from Coverage Check to Reporting

Nine steps, grouped into five stages, in the order your claims move through them. Our AAPC/CPC Certified Coders and Billers work each one inside your existing EHR/PM system. For what we offer, see our revenue cycle management services.

Step 1: Coverage and Authorization Checks

Many claim problems start before the visit. Your practice registers the patient, and we check the patient and insurance details we receive, verify eligibility and benefits, and handle prior authorization ahead of the service.

2026 update: From January 1, 2026, CMS generally requires Medicare Advantage plans, Medicaid and CHIP fee-for-service programs, and Medicaid and CHIP managed care plans to meet federal deadlines for prior authorization decisions on medical items and services (not drugs), and to give a specific reason when they deny a request. Source: CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) fact sheet, Jan. 17, 2024.

Step 2: Coding and Charge Capture

Clean claims start with complete charges and accurate codes. Charges are entered from the clinical documentation, and our AAPC/CPC Certified Coders and Billers check that each ICD-10, CPT and HCPCS code matches the provider's note.

2026 update: ICD-10-CM diagnosis codes change every year. The CDC's FY 2027 release applies to services from October 1, 2026, and replaces the April 1, 2026 update, so we code each claim with the code set in effect on its date of service. Source: CDC National Center for Health Statistics, ICD-10-CM files.

Step 3: Claim Checks and Submission

Before a claim goes out, we scrub it with payer-specific claim checks, including CMS National Correct Coding Initiative (NCCI) edits for Medicare claims. Clean claims are sent electronically, and we work the clearinghouse responses.

  • Claim scrubbing with payer-specific claim checks
  • Electronic claim submission through a clearinghouse
  • Rejected claims corrected and sent again

Step 4: Payments, Denials and Follow-Up

When a payer processes a claim, we post the payment and check it against your payer contracts and fee schedules. Denials are traced to their root cause, and open claims and patient balances are followed up.

2026 update: Starting in 2026, Medicare pays physician fee schedule services under two conversion factors, one for qualifying alternative payment model (APM) participants and one for everyone else. We check Medicare payments against the conversion factor that applies to the provider. Source: CMS fact sheet, CY 2026 Physician Fee Schedule final rule (CMS-1832-F), Oct. 31, 2025.

Step 5: Reporting and Review

Reporting closes the loop on the revenue cycle. You see what happened to your claims and why, and we use what the reports show to fix problems at earlier stages, so they're less likely to return.

  • Reports by payer, provider, location and CPT
  • Claim audits against current payer rules
  • Findings fed back to earlier stages
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Reporting by Payer, Provider, Location and CPT

Each report uses those four views, so you can compare providers and locations side by side and spot slow payers early. Your report schedule is set out in your service agreement.

By Payer
By Provider
By Location
By CPT

Where Revenue Slips Away

Revenue rarely disappears in one big loss. It goes a little at a time: coverage nobody checked, a code that doesn't match the note, a denial that sat in a queue, a payment posted short and never questioned. Each stage of the revenue cycle is a point where one of those problems can be caught before it costs you.

Who Does the Work

Coding and claim follow-up are done by AAPC/CPC Certified Coders and Billers. They work inside the EHR/PM system you already use, including Epic, athenahealth, eClinicalWorks, NextGen, Tebra and AdvancedMD. You keep ownership of your data, and we're HIPAA compliant.

How we protect patient data
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Related Services

RCM Process Questions

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What are the steps of the RCM process?

The RCM process runs from coverage checks before the visit to reporting after payment. MedixCode works nine steps in five stages: eligibility and benefits verification with prior authorization, charge capture and coding, claim scrubbing, claim submission, payment posting, denial management, Accounts Receivable follow-up, patient billing and reporting.

What are the three phases of the revenue cycle?

The revenue cycle is usually split into a front end, a mid cycle and a back end. The front end covers registration, coverage checks and prior authorization; the mid cycle covers charge capture, coding and claim submission; the back end covers payments, denials, follow-up on unpaid claims, patient balances and reporting. Your practice handles registration, and our work starts with the coverage checks.

Why does the order of the RCM process steps matter?

Each step depends on the one before it. Coverage and prior authorization are checked before the visit, coding and charge capture follow the visit, and a claim is checked and submitted only after that. Payments and denials are worked next, and reporting closes the loop by sending fixes back to the earlier steps.

Where do claims usually get stuck in the revenue cycle?

Claims tend to stall at a few points: coverage or authorization that wasn't confirmed before the visit, codes that don't match the documentation, rejections at the clearinghouse, and denials or underpayments that nobody followed up. Each stage of the RCM process has its own checks, so we check for these problems at the stage where they start.

Is credentialing part of the RCM process?

Credentialing and payer enrollment come before the revenue cycle starts, because a provider can't bill a payer they aren't enrolled with. Credentialing is available as a separate service.

What does the reporting step of the RCM process show?

It shows which claims were paid, denied or are still open, split by payer, provider, location and CPT code. We then use those results to correct the earlier steps.

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See How Each Stage Would Work for Your Practice

Book a free consultation, tell us where your claims get stuck, and we'll walk you through how each stage would run for your practice.

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