{"version":"0.38.0","built_at":"2026-10-24T19:53:00.313Z","license":"CC BY 4.0 © Mike Reams","canonical":"https://catalog.mikereams.com","capability":{"id":"BC-1840","name":"Revenue Cycle","level":1,"parent_id":null,"l1_id":"BC-1840","industry":"healthcare","macro_id":null,"path":["Revenue Cycle"],"description":"Get paid correctly and on time for the care the organization delivers, by capturing every charge, coding it accurately, submitting clean claims, overturning wrong denials, collecting patient balances fairly and negotiating payer contracts that pay what care costs. Adjudicating claims as a health plan and the general ledger are owned elsewhere.","aliases":["RCM","Revenue Cycle Management","Patient Financial Services","Patient Accounting"],"in_scope":["Chargemaster, charge capture, revenue integrity and price transparency files","Clinical coding, clinical documentation improvement and coding audit","Claim submission, remittance posting, denials, appeals and underpayments","Patient statements, payment plans, self-pay collections, payer contracting and the cost report"],"out_of_scope":["Adjudicating and paying claims as a health plan (see BC-1870.40)","Front-end eligibility, authorization and estimates (see BC-1810)","Revenue recognition and receivables accounting (see BC-250)","Value-based and risk-sharing contract performance (see BC-1860.30)"],"csdm_note":"Record as a Business Capability realized by the EHR patient accounting and coding modules, a clearinghouse and claim scrubber, contract management and denial analytics Business Applications; align it to internal patient financial Business Services.","status":"active","successor_id":null,"child_ids":["BC-1840.10","BC-1840.20","BC-1840.30","BC-1840.40","BC-1840.50","BC-1840.60"]},"crosswalk":{"realized_by":[{"product_id":"PR-630","product":"Epic","pc_id":"PC-630.40","pc":"Revenue Cycle","maturity":"core","via":"BC-1840.10.20"},{"product_id":"PR-640","product":"Oracle Health","pc_id":"PC-640.40","pc":"Patient Accounting","maturity":"core","via":"BC-1840.10.20"},{"product_id":"PR-640","product":"Oracle Health","pc_id":"PC-640.50","pc":"Contract Management","maturity":"strong","via":"BC-1840.60.20"},{"product_id":"PR-640","product":"Oracle Health","pc_id":"PC-640.60","pc":"Health Information Management and Acute Case Management","maturity":"strong","via":"BC-1840.20.10"},{"product_id":"PR-640","product":"Oracle Health","pc_id":"PC-640.95","pc":"Oracle Health Payment","maturity":"partial","via":"BC-1840.50.20"},{"product_id":"PR-650","product":"MEDITECH Expanse","pc_id":"PC-650.40","pc":"Revenue Cycle","maturity":"core","via":"BC-1840.30.10"}],"used_in":[{"vs_id":"VS-510","vs":"Encounter-to-Cash","stage_id":"VS-510.10","stage":"Capture Charges","order":1,"via":"BC-1840.10"},{"vs_id":"VS-510","vs":"Encounter-to-Cash","stage_id":"VS-510.20","stage":"Code","order":2,"via":"BC-1840.20"},{"vs_id":"VS-510","vs":"Encounter-to-Cash","stage_id":"VS-510.30","stage":"Bill the Payer","order":3,"via":"BC-1840.30"},{"vs_id":"VS-510","vs":"Encounter-to-Cash","stage_id":"VS-510.40","stage":"Post & Reconcile","order":4,"via":"BC-1840.30"},{"vs_id":"VS-510","vs":"Encounter-to-Cash","stage_id":"VS-510.50","stage":"Work Denials","order":5,"via":"BC-1840.40"},{"vs_id":"VS-510","vs":"Encounter-to-Cash","stage_id":"VS-510.60","stage":"Bill & Collect from Patient","order":6,"via":"BC-1840.50"}],"patterns":[],"stacks":[],"books":[],"technology":[{"id":"TR-150.50","name":"Healthcare Claims Clearinghouses & Billing Systems","domain_id":"TR-150","via":"BC-1840.20"}],"frameworks":[],"principles":[],"data_concepts":[],"domain_events":[]},"ancestors":[],"children":[{"id":"BC-1840.10","name":"Revenue Integrity","level":2,"child_count":4},{"id":"BC-1840.20","name":"Medical Coding","level":2,"child_count":5},{"id":"BC-1840.30","name":"Claim Submission & Remittance","level":2,"child_count":5},{"id":"BC-1840.40","name":"Claim Denials & Appeals","level":2,"child_count":6},{"id":"BC-1840.50","name":"Patient Billing & Collections","level":2,"child_count":5},{"id":"BC-1840.60","name":"Payer Contracting","level":2,"child_count":6}]}