Revenue Cycle Management (RCM)

Top 5 Challenges with Healthcare Revenue Cycle Management

If you have ever come across or worked in a healthcare organization, you must be aware of the importance of medical claims and how it can put financial constraints in your revenue cycle when rejected. The administrative work of a healthcare facility is different from other industries as a clinical treatment is not always shorter and prone to complex procedures, starting from a patient’s appointment to the account closure.

The non-medical works include taking care of all the documentation, eligibility verification, demographic entry, billing and coding and filing of the medical claims. If a single step is overlooked, the claim will be rejected. Thus, a disorganized revenue cycle management can lead to a stockpile of uncollectible with no proper process to streamline it.

Following are top 5 challenges in Healthcare RCM:

  1. Billing and Collections Mistakes

A poor billing process can result in millions of dollars in losses. Since patients are now more responsible for out-of-pocket expenses, hospitals must ensure that they make all the necessary collections without putting too much pressure on the patients so that they don’t feel forced to go to another healthcare facility. Without proper and streamlined collection procedure, hospitals may be unable to get maximum revenue at the point of service. To ensure financial stability, despite the dynamic world of revenue cycle management, hospitals need an efficient medical billing process manned by competent staff.

It’s good practice for a provider to have a competent medical billing process in place. This can help ensure that payments are received without delay. It’s also beneficial for a provider to employ an efficient, well trained medical billing staff that understands the importance of the quality and integrity of the data that they deal with daily.

  1. Collection from Patients

One of the top revenue cycle management challenges for healthcare organizations is collecting payments from patients at or before point-of-service. While collecting payments before a patient leaves the office can save time and efforts with collections, most providers say that it is an arduous task. Collecting at point-of-service has become ever more complicated since many patients cannot afford to pay medical bills upfront and many deductibles are risen.

Healthcare organizations struggle with ensuring that debts are collected while not pressuring the patients so much that they seek care at other facilities. Hospitals need to develop a better understanding of patient responsibility and devise more streamlined methods of collecting payments from their customers if they are to maintain financial stability in a quickly changing landscape.

  1. Tracking Claim

Another substantial challenge to healthcare revenue cycle management is tracking a claim through its entire lifecycle. Healthcare professionals should be monitoring claims processes closely in order to pinpoint where errors are being made.

Revenue could potentially be lost if providers cannot identify where issues originated and resolve errors quickly. Providers can usually receive automated alerts that address why payers are routinely denying claims for specific procedures or codes.

  1. Employee Training

If healthcare staff members are not trained effectively, they might not bill correctly or capture patient data correctly. Healthcare staff who are responsible for billing need to know how to properly capture a patient’s demographic information on the front-end, and how to translate that data to successful insurance claims after that.

Staff training has also become a significant pain point for many healthcare organizations. Many claim reimbursement issues stem from human errors, such as improper coding, missing items in a patient’s account, and insurance eligibility issues. Healthcare organizations should invest in regular employee education programs that promote proper coding techniques, comprehensive chart documentation, and financial policy reminders. These training sessions have been linked to better return on investment, such as lowering turnover rates and reducing medical errors.

  1. Use of Technology

Revenue cycle management requires healthcare professionals to use information technology to keep track of claims through their entire lifecycle. This is necessary to ensure payments are collected and denied claims are addressed. However, some hospitals struggle to put information technology and billing infrastructure in place in a way that successfully manages claims as well as large outpatient networks. In today’s healthcare environment, effective health information technology is essential. Unfortunately, not all hospitals and clinics have the capital or infrastructure to invest in new technologies or even required technologies, such as EHRs.

As a result of not being able to implement required technologies, some providers end up consolidating, while others turn to outsourcing. Other types of new technologies may offer medical benefit but require providers to make a substantial capital investment. It can be challenging for an administrator to determine which technologies to use and how much to send. Providers should turn to information technology consultants to help aid them in decision making. It’s even better if a healthcare facility can have an IT expert onsite at all times to handle any IT-related issues.

Medical Billers and Coders (MBC) provide complete revenue cycle management services, covering more than 15 specialties. Our services can help in reducing healthcare operational costs while streamlining the healthcare revenue cycle management at the same time. We can help you overcome the revenue cycle management challenges posed by the healthcare industry by adhering to the highest ethical, legal and practical business standards of the healthcare industry. To know more about our services you can call us at 888-357-3226 or write to us at


Medical Billers and Coders

Catering to more than 40 specialties, medicalbillersandcoders is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.

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