Why Healthcare Facilities Should Adopt a Clinically Driven Revenue Cycle

September 3, 2022

Revenue cycle management (RCM) has always been a clinically driven function. Since without clinical care, healthcare facilities and medical practices will not have any claims to bill. Hence, providers rely on clinical documentation to create and complete compliant claims. As a result, the likelihood of clean claim submission and the reimbursement rate will be increased for a steady cash flow.

Thus, this guide will explore why practices and hospitals should adopt a clinically driven revenue cycle management.

Reasons to Adopt a Clinically Driven Revenue Cycle Management

A Transformation

To successfully benefit from a clinically driven revenue cycle management solution, practitioners must realize that it is a transformation, not an IT implementation. It transforms how the practice operates and requires time for it to happen, as it cannot occur overnight. Process, people, and technology are all equally essential for embracing it.


Healthcare organizations and practices - must provide their staff with the required resources and leadership to understand the importance of adopting and advancing their knowledge to do their jobs better.


While building a new process, or changing current ones, take the 'right people, right time' approach.


Intentionally implementing and using systems supporting the goals and vision of the practice is necessary to shift to a clinically driven revenue cycle.

Improved Patient Care

A clinically driven revenue cycle management (RCM) solution provides an opportunity for consistency. It eliminates the time-consuming audits and reviews of patient visits that may cause claim delays. Additionally, patient care should be at the center of all practices. It offers real-time documentation, enabling quick accessibility of information to clinicians and other authorized individuals, to provide better care services.

For example, automated patient status in real-time throughout the facility drives clinical documentation improvement, and using physician order for observation helps in identifying potential observation carve-outs. As a result, practices gain consistent charging that is compliant with Medicare rules, decrease the risk of double billing time.

Increased Revenue

When you improve your care delivery it naturally translates into increased revenue. Because when patients receive efficient treatment, the referral rate, and retention rate upsurge. Moreover, reducing the claim denial rate provides practices room to reinvest into scaling their care facilities.

Reduced Denials

Simultaneously, practices using a clinically driven revenue cycle management solution depend on clinical documentation to convert into billable charges with specific requirements for financial and compliance reporting will enhance practice’s revenue with better denial management.

Real-time transaction management can lead to correct accountability of the budget owner to ensure error-free tracking of care volume provided by clinicians. Because once you align all of your clinical aspects with revenue cycle management (RCM) best practices, your practice will experience fewer denials, ultimately improving the financial health of your care facility.

Cost Effectiveness

With clinically driven RCM you tend to automate repetitive tasks enabling you to save your time, effort, and money on secondary activities and direct focus on more significant duties such as providing patient care.

Bottom Line

Discussed above are the key reasons why practices should focus on a clinically driven revenue cycle, whether they have it on-premises or go with third-party revenue cycle management solutions to meet their revenue goals.