Revenue Cycle Management Challenges and How to Overcome?

July 26, 2022

With the drop in cases of COVID-19 across the world, life is slowly getting back to normal. To minimize the impact of pandemic, healthcare organizations are focusing on making data-driven decisions to provide quality care. but there are some challenges involved in revenue cycle management (RCM) that are affecting this industry. Before taking a look at the challenges and their solutions, first, let’s start with the revenue cycle.  

What is RCM?

Revenue cycle management (RCM) is defined as the financial process used to manage both administrative and clinical tasks. Claims processing, payment and revenue generation comes under the umbrella of RCM.

Challenges with RCM

Some of the core challenges with the RCM are stated below:

· Precise Coding and Billing

To ensure a smooth cash flow, practices need to have precise coding and billing. The whole process needs to be effective and owing to the complexity, it must be carried out with the help of experts. Only error-free claims will result in timely reimbursements and will assist the practice in achieving revenue goals. This issue can be addressed by hiring qualified and experienced teams who know how to file a clean claim.

· Compliance Standards

The goal is to safeguard the patient’s medical information as any leak of information will result in serious consequences. The RCM in healthcare needs to meet compliance requirements to help the practices grow further and to deliver quality services.

· Collecting Payments Timely

It is one of the biggest challenges practices are facing nowadays as they are struggling to collect reimbursements timely. Money is the fuel to run any practice and when it doesn’t come quickly, it affects the operations, making it difficult to run them smoothly. The only way to overcome these issues is to file an error-free claim so that the collections can be cleared in a timely manner.

· Spending Extra Time on RCM

Optimizing the revenue cycle management solution helps the practices to deliver quality care and make people's experience healthier. Most organizations lack the resources and tools to manage the revenue cycle effectively. Due to this, the teams spend too much time managing the cycle instead of focusing on other important tasks.

· Lacking Deep Insights

To get deep insights into the revenue cycle, the healthcare providers need to have the right tools that will give complete visibility into the process. Key performance indicators such as cost to collect and denial rates need to be measured at regular intervals to build a stronger RCM.

Things to Look for in an RCM Partner

As per global market insights, “The RCM market exceeded $110 billion in 2021 and will be witnessing a CAGR of 12.7% from 2022-28”. If you are looking to overcome the challenges associated with your RCM, the easiest way is to search for the right revenue cycle management partner. Here are some of the things that you will be looking at:

· Exceptional Software

When you buy robust medical billing software, the whole billing process will become much easier. It will become seamless to process claims and verify the eligibility of the patients.


To reduce administrative burdens, the right approach is to outsource the revenue cycle. With the help of a third party, you can significantly increase your clean claims rate.

· Track Record

Before making any final decision on RCM advisory, you need to take a look at the track record of the company as it will help you a lot in making the right decision.

Final Thoughts

Practices are facing a lot of challenges and to overcome these issues, the right way is to get RCM advisory services. These services will help a lot in not only finding the right solution but also help the practices in identifying the loopholes in their process. In this way, practices can reduce the denial rate and streamline revenue to improve collections.