Revenue Cycle Management Challenges

Revenue Cycle Management Challenges and How to Overcome Them

Revenue Cycle Management (RCM) is a critical financial process that healthcare providers must use to track patient care services from registration to the final payment of a balance. RCM is essential to ensure revenue, financial viability, and reliable collections, which ultimately aid in delivering quality care to patients.

However, RCM is an intricate process bound with many difficulties, such as industry regulations & compliance, medical coding and billing, staff training & education, and interoperability and data integration. These challenges can lead to massive revenue loss if left unresolved. Moreover, with the increasing demand for remote patient monitoring services, RCM has become even more complex.

According to Advanced Systems Corporation, healthcare providers lose up to $125 billion every year due to medical claim denials, coding mistakes, and missing patient payments.

Let’s take a look at a few of the challenges being faced by Revenue Cycle Management and How to Overcome Them.

Industry Regulations and Compliance

To ensure that a patient’s personal information is protected from any privacy breach, it is important that your revenue cycle management system works in tandem with the Healthcare Information Portability and Accountability Act 1996 (HIPAA).

Healthcare fraud and abuse laws can result in penalties and severely affect your medical practice. HIPAA mandates standardization of medical codes, regular compliance audits of the facility, electronic filing of medical claims, foolproof workstations, restricted access control to medical records, and access only on a need basis. Password-protected access to the software and online coding software is also required.

As a healthcare provider, you must safeguard the privacy, security, and confidentiality of protected health information (PHI) by charging honestly and sticking to all the mandated protocols and guidelines of HIPPA

Medical Coding & Billing

Medical coding and billing are essential for practice, as they are directly related to a practice’s income. However, as per the National health insurer report, around 20% of the claims paid are incorrect, and healthcare organizations have to bear a loss in the range of 4%-12% of their total entitled money.

To receive the designated amount, your organization must employ well-credited medical coders and billers who are experts in denial resolution, claim follow-up, bill adjustments, claim appeal submission, etc.

Collaborating with an expert vendor who has expertise in the ICD-10 & ICD 11 coding systems can also help safeguard a positive cash flow in your organization, eventually boosting your revenue cycle.

Medical Coding Billing

Staff Training and Education

Proper training of healthcare workers is essential to ensure that the hospital runs smoothly. From billing to capturing the information of data, everyone needs to be trained properly so that there is no hiccup anywhere in the process.

Improper coding, missing items when collecting patient data, wrong billing, inputting wrong dates, policy reminders, and chart documentation- all of this will go wrong if the staff is not trained properly.

These training sessions will directly impact your return on investment (ROI) as they will lead to reduced coding and billing errors as well as lesser turnover rates.

Staff Training and Education

Interoperability and Data Integration

To run the hospital facility seamlessly, It is essential for departments to have a smooth exchange of data and information among them. If not, it can result in increased hospital costs and loss of time.

With the help of Interoperability, communicating and exchanging data within the systems is easy. However, traditional organizations might discourage the sharing of data, which is a huge issue in the autonomous nature of hospitals.

In order to provide the best possible care to patients, it’s essential that healthcare workers have access to their data. This includes being able to integrate the data seamlessly with any other system that they may be using. One way to achieve this is by adopting universal standards in healthcare technology.

Data Integration medical


Revenue cycle management can be a major challenge for healthcare facilities, with each practice encountering its own unique obstacles. These may include industry regulations & compliance, medical coding, and billing, staff training & education, and interoperability and data integration. However, there are solutions available to help address these issues, such as medical and coding software, as well as proper training for staff. Additionally, incorporating RPM services can provide an additional layer of support to revenue cycle management. Overcoming these challenges can have a significant positive impact on revenue cycle management, allowing healthcare facilities to operate more smoothly and effectively.

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