Problem
High Denial Rates
The claim denial rate reached 11.99% in 2023. High frequency can signal issues with your billing process. Common causes include incorrect patient information, coding errors, and missing documentation.
Delayed Payments
Long gaps between service delivery and payment receipt can indicate inefficiencies in your billing and collections process.
Low Patient Payment Rates
Difficulty in collecting payments from patients could indicate inadequate payment options or communication issues.
Numerous Patient Complaints
Complaints about billing transparency or accuracy can signal underlying problems in your revenue cycle management.
Solution
Client Management Team
Consider hiring healthcare RCM professionals who specialize in maximizing revenue cycle efficiency.
Professional Revenue Cycle Assessment
Get an expert evaluation of your revenue cycle processes to identify and address inefficiencies.
Problem
Low Clean Claim Rate
A low percentage of claims being accepted on the first submission suggests problems with the accuracy and completeness of your claims.
Increased Days in A/R
If your A/R days exceed industry benchmarks (30–50 days is ideal), it means your practice is waiting too long to get paid, affecting cash flow.
Underperforming Key Performance Indicators (KPIs)
If your revenue cycle KPIs like net collection rate and denial management rate are underperforming, it’s time to reassess your processes.
Solution
Invest in Technology
Implement advanced analytics, billing software, and automated tools to streamline your revenue cycle management.
Problem
Frequent Billing Errors
Regular mistakes in billing, such as incorrect patient info or service codes, can lead to payment delays and revenue loss.
Solution
Compliance, Staff Training & Education
Regularly train your staff on the latest billing codes, compliance requirements, and best practices.
Solve Common RCM Problems with the Right Resources
If you’re experiencing any of these RCM red flags, you’re not alone. Check out our in-depth explanation.
If you’re curious about how end-to-end RCM services could help your organization, let’s chat.
