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What Is The Solution For The Complicated Revenue Cycle Process?

Any clinic or healthcare facility administrator or hospital manager knows that the cornerstone of a financially strong and stable healthcare facility is a robust revenue cycle, but there are revenue cycle problems. However, Doctors and practitioners face immense financial pressure along with challenges such as out-of-pocket costs for patients, the price transparency demand, complex payer contracts, etc. Medical practices and hospitals face many revenue cycle management issues and must ensure the revenue cycle runs at maximum efficiency to return them the maximum, apposite revenue.

The revenue cycle is involved in every step of a patient’s interaction and relationship with the medical practice. From appointment to the patient’s balance payment in full, many areas are there where the process of revenue cycle can fall short.

To help you improve revenue cycle management and overcome the key complications in the revenue cycle and its overall performance, we’ve outlined revenue cycle management challenges with solutions.

Without further ado, here we go.
Challenge # 1

Steps In Managing The Revenue Cycle: Verifying Insurance Coverage Of Patients

Changes in the insurance compliances and coverage make it more complicated for hospitals to verify patient insurance eligibility. Evaluating a patient’s responsibility of payment for procedures like surgery is larger than ever and requires more action from the facility to verify it and then collect revenue. Hospitals face failure to collect the funds. The collection of dues at the service provision time could result in a larger percentage of accounts receivables being directed to external agencies for collection. Statistics and data show that patient balances are more aberrant due to larger deductibles, unpaid co-insurances and co-payments, and a lack of complete information on insurance.

Solution: Electronic Verification Of Insurance Coverage

The best revenue cycle management process improvement solution is to acquire any software that interfaces with the systems of the payer and lets users verify insurance coverage quickly at the time of appointment scheduling. It helps healthcare facilities avoid additional costs associated with claim denials and prolonged payment reimbursement. The two-way communication between the systems can add valuable insurance information automatically to the patient’s record. The information like co-pay or deductible amounts can be evaluated and used for reporting purposes.

Challenge # 2: Patient Payment Collection

It is critical to a facility’s financial health to collect the patient’s payment responsibility in a majority on the day of service provision. Past-due accounts of patients can cause delays in the revenue cycle and its management, and to turn over these accounts, a large amount of staff time is required.

Solution: Automatic Turnover Account Collections

Improving hospital revenue cycle management involves practice management solutions that let you turn over accounts to a collections agency electronically. An efficient PMS streamlines these processes and provides your staff with valuable information. The PMS should display the status of “in collections” in the patient’s record, and notification configurations help staff avoid new patient cases appointment scheduling who have an account in collection.

Challenge # 3: Inaccurate And Incomplete Charges

If practice administration and/or charting involve several manual steps, incomplete or inaccurate billing can occur easily. Unnecessary delays and denials can happen if there is inaccurate coding, payer requirements changes, and missed charges for plates, screws, and implants.

Solution: Integration of Clinical Documentation Electronically

When integrated with your PMS, an electronic clinical documentation system is the perfect revenue cycle solution. It ensures information like the usage of materials and supplies captured during the surgical or clinical procedures and transferred accurately to your billing system.

Most modern administrative and clinical solutions have features like prebuilt code dictionaries to help keep your billing process up to date.

Challenge # 4: Turnover And Disruptions Of Billing Staff

Hospitals and many surgery centers have a small team, and most only have one or two employees for claim submission and billing. Additionally, if your clinic has a high turnover rate, the staff shortage can result in revenue peaks. New or inexperienced billers, coders, or an inadequate onboarding process can land you in revenue leakages. Inconsistency is Staffing can contribute to the submission of a claim in low numbers per day, delay in payments and claim denials, and an increase in accounts receivable aging accounts.

Solution: Outsource Billing And Coding Tasks To A Professional Company

Using professional services for revenue cycle management and financial health strategies is the best solution for hospitals and clinics. Choose wisely the one with a proven track record to provide consistency in your revenue cycle. Outsourcing billing and coding can establish a solid foundation for the clinic’s financial stability.


Revenue Cycle Management is not a child’s play; not every practitioner can efficiently manage it. Professional revenue cycle management companies like GreenSense Billing have an entire team of certified coders and billers to optimize your billing and coding processes, manage and improve claim denials and submission, and elevate revenue collections. Most importantly, you get financial peace of mind by outsourcing revenue cycle processes, and you can focus on other things like physician and patient satisfaction. Interested in knowing more about our revenue cycle solutions? Reach out to us today.

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