Revenue cycle management is a crucial process for medical practices looking to streamline operational processes and achieve better financial success. However, there are a variety of challenges that keep healthcare providers across the US looking for answers to their financial and administrative woes.

Healthcare technology is already revolutionizing the revenue cycle for many healthcare organizations that have embraced it. Read on to learn more about these pervasive challenges and the innovative solutions built to solve them.

If you would like more information on the basics of the healthcare revenue cycle, read our companion article, What is revenue cycle management in healthcare?

What are common challenges of revenue cycle management in healthcare?

Revenue cycle management in healthcare can present a variety of challenges, for healthcare organizations of all kinds and sizes.

Here are some of the most common:

Complex insurance billing and coding rules

Every payer has its own rules and policies for medical coding and billing. Keeping up with these evolving rules can be time-consuming, especially when working with a large variety of payers, as many practices do. Any errors or inaccuracies typically result in a slower time to payment, or increased denials.

Using an interoperable healthcare platform that can verify benefits with the insurance provider in real-time can greatly help address this challenge. Platforms like athenaOne also provide dedicated servicing alongside the technology, so practices can work with support staff with a nuanced understanding of specific payer expectations.

Evolving healthcare regulations and policies

The US healthcare industry is regulated at both the local and federal levels. These regulations are ever-changing and can have significant impacts on a healthcare practice’s bottom line. Healthcare organizations need to mitigate the risks of non-compliance, but doing so manually is difficult.

Healthcare regulations, especially for Medicare and Medicaid, are updated annually and impact how providers are paid and what reporting requirements organizations must adhere to. Having a medical billing software that is updated with these changing policies and provides data for required reports helps make this challenge more manageable.

Staffing and training issues

Across the US healthcare industry, practices are struggling to hire and retain qualified staff to help manage the revenue cycle. Specialized roles like medical coding and medical billing can be especially difficult to staff, with high turnover rates. For this reason (and others), innovative technologies built specifically for the needs of healthcare organizations and specialized medical billing services are helping bridge the gap.

Technology limitations and interoperability challenges

In many healthcare organizations, the RCM solution software is silo-ed from other core functions like electronic health records and patient engagement tools. This lack of integration can introduce more opportunities for errors, and generally makes the process less efficient. Practices should look for an integrated, interoperable platform to mitigate these challenges.

Why is optimizing your healthcare revenue cycle important?

Optimized revenue cycle management is more crucial than ever in US healthcare, where more than 62% of physicians worry about the financial stability of their practice.¹ Let’s take a closer look at some the benefits of a well-managed revenue cycle.

• Improved cash flow and revenue generation: Effective RCM processes optimize the collection of payments, resulting in improved cash flow for healthcare organizations. By reducing claim denials, minimizing payment delays, and increasing payment accuracy, organizations can better manage their finances and meet their financial obligations.
• Reduced claim denials and rejections: A major benefit of revenue cycle management is that it helps minimize claim rejections and denials. By implementing proper coding practices, improving documentation accuracy, and staying up to date with billing regulations, organizations can substantially reduce claim denials, saving both time and money.
• Enhanced efficiency and productivity: Revenue cycle management streamlines administrative processes and reduces manual errors, leading to improved operational efficiency. Automation of tasks such as patient registration, eligibility verification, coding, billing, and claim submission helps save time and resources, enabling staff to focus on patient care.
• Increased patient satisfaction: Efficient revenue cycle processes contribute to a better patient satisfaction. Accurate and transparent billing, minimal billing errors, and efficient claims processing contribute to a more positive financial experience for patients, which in turn improves patient satisfaction and loyalty to the healthcare organization.
• Compliance with regulatory requirements: Successful revenue cycle management helps ensure compliance with healthcare regulations and guidelines. By staying updated with coding and billing requirements and implementing proper documentation practices, healthcare organizations can protect themselves from compliance-related risks.

How can technology help healthcare organizations with revenue cycle management optimization?

Integrated healthcare technology solutions that combine an electronic health records system with a practice management solution and a patient engagement solution can help your practice streamline and optimize its revenue cycle. For independent practices, specialties, and ambulatory care centers, an all-in-one solution like athenaOne provides these core benefits. Enterprise healthcare systems with many facilities can leverage the power of athenaIDX™ for larger scale implementation.

Here are some of the benefits of using a platform like athenaOne or athenaIDX.

1. Automated key revenue cycle management tasks

RCM and practice management technology can automate various parts of the revenue cycle, such as patient registration, eligibility verification, charge capture, claims submission, and payment posting. Leveraging a healthcare IT platform built with automation capabilities of these kinds can reduce manual errors, improve efficiency, and accelerate the revenue cycle, helping providers get paid faster.

2. Core healthcare IT system integration:

Some healthcare platforms, such as athenaOne integrate core functions, like electronic health records, patient engagement, and revenue cycle management, into one comprehensive platform. This integration allows for more seamless data exchange, real-time updates, and streamlined workflows, reducing duplicate data entry and improving accuracy.

3. Real-time analytics and streamlined reporting:

Providers looking to optimize their revenue cycle should choose a healthcare IT platform that provides robust analytics and reporting capabilities, allowing organizations to track key performance indicators, identify trends, and make data-driven decisions. This helps optimize revenue cycle performance, identify areas for improvement, and monitor financial health. Reporting of this kind is also key for practices participating value-based care programs with specific reporting requirements for the quality of patient care and outcomes.

4. Patient engagement and self-service:

An integrated healthcare IT platform will offer patient portals, online bill payment options, and automated appointment reminders. These patient-centric resources help improve patient satisfaction, reduce billing inquiries, and increase collections as patients can pay from the app on their phone or through the website. They can also shorten the revenue cycle by enabling patients to self-serve at key moments such as patient registration, appointment scheduling, and patient billing.

5. Medical claims denial management and appeals:

A healthcare technology partner can help streamline the claims denial management processes by automating denial workflows, providing real-time denial analytics, and facilitating efficient appeals. This helps organizations identify and address denial root causes, reduce denials, and maximize revenue recovery. The right technology can make a significant impact here, as evidenced by athenaOne’s clean claim submission rate of 98.4%.² Submitting clean claims is paramount in an industry where nearly 15% of all claims submitted to private payers are initially denied.³

Avoiding denials and subsequent appeals can help practices save money: according to a recent report, hospitals and health systems spent around $19.7 billion trying to overturn denied claims in 2022 alone.⁴

athenaOne® for healthcare revenue cycle management

athenaOne is an all-in-one healthcare platform with robust capabilities for practice and revenue cycle management, electronic health records, and patient engagement. athenaOne’s revenue cycle management tools and services help healthcare organizations manage their financial processes to optimize revenue collection, improve cash flow, and reduce administrative burden for healthcare providers.

Our platform and services automate and streamline every step of the revenue cycle to help you optimize for efficiency and financial health, including:

• Patient registration and eligibility verification
• Charge capture and medical coding
• Healthcare claims submission and management
• Payment posting and reconciliation
• Claims denial management and appeals
• Analytics and reporting for patient population wellness and your practice’s financial health
• Patient billing and collections

Reach out to one of our healthcare IT specialists to learn more about how athenaOne® for small- and medium-sized healthcare practices, clinics, and hospitals or athenaIDX for larger enterprise healthcare organizations can help you streamline RCM processes, improve accuracy and efficiency, and capture more revenue.

1. 2023 Physician Sentiment Survey, commissioned by athenahealth and fielded by Harris Poll, Jan 2024
2. Based on athenahealth data for twelve months ending Mar. 2024; results compared to competitors' self-reporting of clean claim submission rates; M164
3. Premier Inc., Private Payers Retain Profits by Refusing or Delaying Legitimate Medical Claims; https://premierinc.com/newsroom/blog/trend-alert-private-payers-retain-profits-by-refusing-or-delaying-legitimate-medical-claims; IS116
4. American Hospital Association, Payer Denial Tactics — How to Confront a $20 Billion Problem; https://www.aha.org/aha-center-health-innovation-market-scan/2024-04-02-payer-denial-tactics-how-confront-20-billion-problem