When Care Doesn't Talk to the Cashier
RCM (Revenue Cycle Management), claim denials and algorithmic auditing of billing.
This chapter exposes a friction rarely discussed outside hospital back offices: the mismatch between the care delivered and what is actually recorded, billed and paid. The authors explain the concept of RCM (Revenue Cycle Management) and the chronic problem of claim denials, charges rejected by payers, showing how algorithmic auditing of billing can reduce financial losses that ultimately undermine the institution's ability to keep investing in quality care.