Revenue cycle management represents a complex business communication with patients, including insurance verification and both point-of-service and after-service collections. Any mismanagement of these functions can lower patient and revenue and damage the reputation of the organization through avoidable denials and bad debts. No matter the size of a practice, hospital or health system, failure to optimally prioritize Revenue cycle management (RCM) and revenue collection efforts can halt growth, increase operational risk and create an uncertain financial future. According to the research conducted by Black Book, 92 percent of hospitals shifted their main focus to revenue cycle management technology and vendor selection over the last year in response to declining healthcare reimbursements.


While many healthcare providers focus on providing exceptional care services to their patient population, also similar attention to be paid to the business financial health that ensures hospitals or practices can provide the care for the coming years. Physicians are continuously facing challenges to provide the patient with affordable care while facing annual increase care-delivery and administrative costs. Improving point-of-services collections, maintaining healthy account receivables, preventing or reducing unpaid claims and reducing efficient billing and coding process also affects practices profit margin.

According to the nature of healthcare, preventing and reducing unpaid claims to see the greatest profit change is difficult. Specifically, the healthcare business is complex because the cost to provide services is shouldered by the healthcare organization before those services are paid for by either insurance payers or the patient themselves. Because of the length of the claims process, it could be months before a bill is paid in full–if it is paid at all. Almost 95 percent of the practices reported inefficient billing and coding processes, with the majority of needs to implement the backend efforts to restore bills by the end of the year.

Handling difficulty in hospital and small practices financial conditions and change in legislation and regulatory compliance made healthcare providers more difficult to manage certain functions internally. In the last decade, much commercial payer reimbursement shifted to direct patient responsibility with plans that deduct and strengthen the idea that organizations and medical practices must take a closer look at their RCM to evaluate what methods can be implemented to realize the most benefits for all parties involved.