You treat patients, schedule treatments, handle no‑shows
—and somehow your bank balance still feels like it’s playing hide and seek. Every month you wonder: Where’s all the money going?
Here’s the cold truth: if you don’t master the 13 steps of revenue cycle management, you’re leaving tons of cash on the table. Denied claims, billing leaks, uncollected patient balances—they all erode your bottom line. But when you lock down your RCM process, you don’t just stop the bleeding—you build a revenue machine that fuels growth, including a membership program that turns patients into lifetime clients.
I’ll take you through each of the 13 steps, show you how membership ups the ante (MRR, ARR, loyalty, upsells), drop a BoomCloud™ case study, and show why membership patients spend 2× to 4× more when you optimize revenue per patient. Let’s get ruthless.
Story
Dr. Max owned a bustling dental + cosmetic practice. He’d read headline stories about med‑spas and aesthetic clinics raking in more per client than dental offices. One quarter, revenue dipped. Insurance denials shot up. Collections lagged. His team was drowning in adjustments, appeals, patient billing calls.
He realized: He had no clear revenue cycle map. Billing was reactive, parceled out to interns, denials piled up, and patient balances got forgotten.
He hired a consultant, rebuilt his 13‑step revenue cycle, and simultaneously launched a membership tier (with BoomCloud™ backing), bundling preventive + aesthetic perks. Twelve months later:
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Denial rates dropped by 40%
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Days in AR shrank from 68 to 35
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MRR jumped by $25,000
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ARR forecast surged
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Membership patients spent ~3× more than non-members
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The practice stabilized, margins fattened, stress eased
That was his Breakthrough Moment: cleaning up revenue cycles gave him the breathing room to sell membership upgrades, not scramble for new patients.
The 13 Steps of Revenue Cycle Management — What They Mean, Where Practices Slip
Below is a standard breakdown of the 13 steps of revenue cycle management (often found in guides like Cloud RCM, BillFlash, Connext, etc.). Prospect Healthcare Solutions+3Cloud RCM+3BillFlash+3 We’ll not only define them, but show how leaking each step costs you—and how membership models play in.
1. Pre‑Registration / Pre-Check
Before they walk in, collect demographic, insurance, referral info. Mistakes here cascade.
2. Patient Scheduling & Registration
Set expectations, gather copay info, insurance IDs, get signatures, consents.
3. Insurance Verification & Eligibility
Check coverage, benefits, patient responsibility ahead of time, not later.
4. Authorization / Referral Management
Some services require preauthorization or referrals. Get them before you treat.
5. Point-of-Service Collections
Collect copays, deductibles, balances at the front desk. Don’t let them walk out owing.
6. Charge Capture / Charge Entry
Every service, every minute, must be captured in your system accurately. Miss a charge? You lose money.
7. Coding & Documentation
Convert clinical notes to ICD / CPT / HCPCS codes—accurately. A miscoded case = denial or underpayment.
8. Claim Creation & Submission
Build “clean claims” (no errors) and submit electronically (faster, fewer rejections).
9. Payment Posting
When insurance or patient pays, you log it properly—match it, adjust, reconcile.
10. Denial / Rejection Management
Claims denied? Analyze, correct, appeal. Don’t let denials just sit.
11. Patient Billing & Statements
What insurance doesn’t cover becomes the patient’s responsibility. Send clear statements, reminders.
12. Collections / Bad Debt Management
Persistent balancing act: follow up, set payment plans, escalate as needed.
13. Reporting & Analytics / Continuous Improvement
Track KPIs—denial rate, days in AR, collection percentage, net revenue. Adjust processes.
Every step is a link in your revenue chain. If one link is weak—say poor coding, or no pre-registration—you bleed cash.
What Happens If You Botch These Steps
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Denied claims = wasted staff hours + lost revenue
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Delays in submitting or posting = bad cash flow
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Forgotten balances = uncollected patient debt
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No feedback loops = repeating mistakes
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Revenue volatility: feast or famine
Reports from RCM benchmarking show that many providers lose upwards of 40 % of potential revenue due to process inefficiencies and denials. Invensis Some healthcare practices report they lose over $500,000 annually just due to denied claims and weak RCM practices. Invensis
So yes — mastering the 13 steps of revenue cycle management is not optional; it’s survival.
Solution: Membership + Clean RCM = Growth Mach 2
You’ve cleaned up your revenue cycle. Now here’s how membership makes it exponential.
Why Membership Ties Into RCM So Well
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Membership is cash up front—or recurring—so less risk on billing surprises
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You reduce patient friction over bills because they “prepaid” value
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Membership patients behave differently—they show up more, accept treatments, refer
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Because your cash flow is steadier (via MRR), you can invest in systems, staff, marketing
You’re now supercharging revenue per patient. That’s how you scale without just adding chairs.
Sample Membership Tier (Dental + Aesthetic)
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Flat monthly fee (e.g. $99–$179)
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Includes preventive (cleaning, exam) + credits toward Botox, whitening, filler, etc.
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Priority scheduling, discounts, loyalty perks
The membership line becomes a part of your RCM flow. You don’t just bill for services—you manage membership billing, track usage, upsell, retain.
BoomCloud™ is built for this: membership management, automated billing, credit tracking, dashboards (MRR, ARR, churn), decline recovery, retention automation. (boomcloudapps.com)
Once your RCM steps are tight, membership becomes a low-friction upsell that plugs into clean financial foundation you already built.
Case Study: Practice Scales with Clean RCM + Membership
Clinic: Apex Dental & Aesthetics
Initial state: sloppy RCM, erratic revenue, 120 members, average AR 65 days
Phase 1 (Months 1–4):
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Map and fix the 13 steps
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Train registration, coding, denials team
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Implement denial workflow, analytics
Phase 2 (Months 5–8):
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Launch “Smile & Smooth Club” membership
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Package injectables, whitening, priority perks
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Use BoomCloud™ for membership functions
12-month results:
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Denial rate dropped by 35%
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AR days shrank to 33
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MRR rose by $32,000
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ARR projection +$384,000
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Member spend (dental + aesthetic) ~3× non-members
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Membership uptake accelerated new patient referrals
Because they tightened every revenue cycle link, their membership revenue didn’t leak. It compounded.
Breakthrough
Here’s the shift your mind must undergo:
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Before: “I chase new patients to grow, I hope billing works, I get frustrated by denied claims.”
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Crisis: Collections lag, revenue unpredictability, staff burnout from appeals, no bandwidth for membership growth.
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Realization: If I optimize every step in the 13-step revenue cycle, I will free cash, reduce friction, and finally have room to launch membership confidently.
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After: You get paid faster, fewer surprises, more headspace—and membership becomes a scalable engine, not a gamble.
That is the pivot: revenue discipline first, membership second.
Metrics You Must Track: MRR, ARR, Churn, Leakage
You don’t scale blind. These are your levers:
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MRR (Monthly Recurring Revenue): membership fees + recurring billing
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ARR (Annual Recurring Revenue): MRR × 12 (adjusted for churn)
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Churn Rate: % of members cancelling monthly or annually
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Leakage Rate: % of revenue lost to denials, uncollected patient balance, underbilling
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Days in AR: how long until revenue is collected
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Denial Rate: % of claims denied
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Collection Rate / Net Collections: % of charges actually collected
When your RCM leaks shrink, your effective margin per patient goes way up—magnifying membership gains.
Tactical Tips to Nail the 13 Steps & Layer Membership
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Visualize your 13‑step map; identify your weakest links
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Automate where possible (eligibility checks, claims scrubbing, denial workflows)
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Train staff relentlessly—revenue is everyone’s job
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Audit often: spot where claims fail, where charges are missed
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Use analytics & dashboards to monitor trends
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Test membership pilots on best patients first
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Bundle membership perks that patients value (aesthetic, preventive)
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Use scarcity & limited enrollment windows
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Offer winbacks to churned members
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Iterate based on data—never “set and forget”
Start with fixing steps 1–4 (pre-registration, eligibility, auth, charge capture)—those are the biggest revenue leaks.
FAQs
Is the 13-step model standard?
Yes, many RCM guides (Cloud RCM, BillFlash, Invensis) use 13 steps to fully detail the cycle. Cloud RCM+2BillFlash+2
Can a membership model coexist with insurance billing?
Absolutely. Use membership for elective, aesthetic, loyalty services; insurance/billing for covered services. The membership revenue softens the dependency on insurance cash.
How fast can you see results after fixing RCM?
Some clinics see improved cash flow in 3–6 months. Membership impact might show in 6–12 months.
Does membership require new staff?
Not necessarily—if your RCM is efficient and automated (using tools like BoomCloud™), existing staff can support membership.
What’s acceptable churn?
Aim for monthly churn under 5–8%. Annual retention over 85%.
Conclusion
The 13 steps of revenue cycle management are your financial spine. Clean each vertebra, eliminate leaks, and suddenly your practice has breathing room. That’s when membership isn’t a distraction — it’s a growth engine layered on rock-solid income.
Fix your RCM, then layer membership + injectables, tracking MRR, ARR, churn, leakage. The compounding gains will blow your mind.
Want help mapping your 13-step audit, designing your membership tier, or modeling revenue projections? I’m ready.
Resources / Next Steps:
Download the million‑dollar membership plan ebook — https://boomcloud.myclickfunnels.com/million-dollar-book
Take The Six‑Figure Patient Membership Plan Course — https://www.boomcloudapp.com/six-figure-membership-course
Schedule a Demo of BoomCloud™ & Learn how to manage & grow your membership plan — https://boomcloudapps.com/demo-schedule/
Create Your BoomCloud™ Account For FREE — https://www.boomcloudapp.com/main-online-demo-and-sign-up-page
