Three Revenue Cycle Management Problems Will Stop Medical Groups Revenues & Why You Should Outsource?

3 Revenue Cycle Management problems will Stop Medical Revenue

Medical practices often do not have the time to work on unbilled claims, claim denials, and accounts receivables, resulting in lost revenue and reduced cash flow due to having manage the office and patient care. Not being able to address these issues will result in delayed payments, denied claims, increased accounts receivable, and administrative costs. Effective management of these areas can improve financial stability and help medical practices create a better patient experience.

Here is why these 3 healthcare Revenue Cycle Management processes are so important?

Claim submission is the first part of the healthcare Revenue cycle management process. When a claim is being billed to the insurance companies the medical practice can earn revenue to keep their business running. Failing to work on claims or keeping backlogs of unbilled claims or charges can cause devastating impacts on the revenue. Most insurance companies do not even consider the claim to be paid if it is being filed after the timely filing limits.

Denial of claims is the revenue cycle roadblock that never leads to collections. Working denials will allow your group to identify the mistakes in credentialing, contracting, coding, eligibility, etc. Honestly, claim denials will allow you to determine whether your group medical billing staff or RCM c are working efficiently and measure the quality of work as well. Accounts receivables are usually pending in most medical practices. If the accounts receivable aging buckets are above 60 days and greater then it slowly loses the chance of ever recovering it and can cause written offs.

Let’s now focus on how to solve these three healthcare Revenue cycle management problems that stop your medical group’s collections.

Unbilled Claims or Charges and the Solutions to Track:

Unbilled Insurance Claims:

Potential Reasons – delayed provider dictation or transcription, coding errors, or rejected claims.

Solution – A good Revenue Cycle Management Company will Generate a report to track unbilled claims and determine the reason for each. Submitting outstanding claims promptly will ensure that revenue will not be lost. Implement a automated process platform or RPA bots for more accurate billing.

Unbilled Patient Balances:

Potential Reasons – Posting errors or failure to send patient statements.

Solution – Implement an automated process where statement is automatically billed and implement an online payment portal for patient payments.

Medical practices should be proactive by reviewing unbilled insurance claims and patient balances regularly and addressing any issues that may arise. This will ensure timely payments and improve the financial health of the practice.

Unworked Denied Claims:

Potential Reasons – Denials can occur for multiple reasons such as missing information, incorrect coding, lack of medical necessity, or policy limitations.

Solution – Medical billing staff should first identify the reason for the denial, identify trends and then take appropriate action to correct the issue or issues. This may involve reviewing the claim for accuracy, obtaining additional information from the provider or patient, appealing the denial with the payer, or resubmitting the claim with corrected information.

Implementing denial management process and robotic process automation (RPA) for denials can assist your medical group even if you have no staff to work the denials. Preventing denials is important for medical billing staff to have a thorough knowledge of payer policies and guidelines, stay up to date with coding and billing regulations, and establish effective communication with providers and payers. Having a quality assurance process and conducting regular audits can also help identify and address issues before claims are submitted, reducing some denials.

Revenue Cycle Management Solutions:

Potential Reasons – The backlog of Accounts Receivables (AR) in medical billing can be a huge challenge for providers. The reasons for a backlog can vary, but some of the most common reasons include claim rejections, denials, incomplete documentation, slow insurance processing, staffing issues, inefficient processes, etc.

One of the primary causes of aged receivables in medical billing is claim rejections. These errors in the initial billing process can lead to claims being rejected, which must then be corrected and resubmitted. This process can be time-consuming and result in no payment since it never made it to the insurance company. Denials will cause most backlogs, as claims must be reviewed and appealed, which can be a lengthy process.

Incomplete or missing documentation can also cause a backlog, as insurance companies may require specific documentation to process a claim. If this documentation is missing or incomplete, it can delay the processing of the claim and lead to a backlog of aged AR.

Slow or backlogged insurance processing is another common issue for a backlog in medical billing. Insurance companies may take longer than expected to process claims for various reasons, which can result in a backlog of pending AR for medical practices.

Staffing shortages can also lead to delays in sending claims and this creates backlog of pending AR. If there are not enough staff members for the workload, it can be challenging to keep up with the volume of claims.

Inefficient processes will cause a backlog in medical billing. Outdated or inefficient processes and information can lead to errors and delays, which will result in a backlog of AR. High volumes of claims can overwhelm a medical billing department and this will always lead to delays in processing and a backlog of aged AR.


Review Accounts Receivable: Start by reviewing the outstanding claims and determining which claims are past the expected payment date.

Contact Insurance Companies: When the outstanding claims are with insurance companies, contact them to find out why the claims are still not processed. You may need to provide additional information or resubmit claims that were denied.

Following up with Patients: If the outstanding balance are with patients, contact the patient to remind them of their outstanding balance and request payment.

Address Denials: If claims have been denied, review the reasons for the denial and take the appropriate steps in correcting the error, or submitting appeals.

Monitor Trends: Keep track of trends and identify any patterns of non-payment or delayed payments. This can help you identify areas where you can improve your billing process.

Review Best Practices: Lastly, review your billing practices and make adjustments as needed to improve turnaround time, efficiency and accuracy. This can help reduce aged AR and improve your overall cash flow.

Implement Automation: Automated solutions offer several benefits for medical billing, including an automatic population of days in AR and when exceeding the standard reimbursement timeframe. Automated claim status checks are performed using EDI transactions and accessing payer portals if permitted by bots. This process could reduce staff burnout by performing repetitive tasks and possibly could increase productivity and ultimately improve quality and turnaround time.

Utilizing these steps can effectively help you manage aged AR in medical billing and ensure that your healthcare practice remains financially healthy.

Hospitals, health systems, and medical groups must focus on these three areas that present challenges and streamline the RCM process. Check out our Professional Medical Billing Company at to learn more.

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