RCM in Medical Billing: 7 Ways to Improve Your Revenue Performance

You submitted a clean claim last Tuesday. Today is Friday, and you still haven’t seen payment. Meanwhile, three other claims came back denied for reasons that make no sense. Sound familiar? In 2025, 41% of providers report denial rates of at least 10%, with claims continuing to face increased scrutiny. Every denied claim and delayed payment chips away at your practice’s financial health while you’re focused on what matters most: patient care.

Understanding Revenue Cycle Management

Revenue cycle management covers every step from the moment a patient books an appointment until you receive the final payment. Think of it as the financial journey of every patient encounter. The process moves through registration, insurance verification, charge capture, claim submission, payment posting and denial management. When any single step breaks down, the entire cycle suffers.

Healthcare providers report a median of 47 days in accounts receivable, up from 41 days just a few years ago. That’s nearly seven weeks between delivering care and seeing payment. For a busy practice, this widening gap creates real problems; staff payroll, supply orders and equipment upgrades all depend on steady cash flow.

Build a Stronger Front End

Your revenue cycle health depends on what happens before you submit a claim. Accurate patient registration and insurance verification prevent downstream problems. When staff captures complete demographic information, verifies current insurance and confirms financial responsibility upfront, you reduce claim denials.

Registration and eligibility issues rank among the leading causes of claim denials. These preventable mistakes include outdated insurance information, incorrect patient data, missing prior authorizations and incomplete documentation. Each error sets off a chain reaction of denied claims, staff time spent on rework and delayed payments that strain your cash flow.

Real-time eligibility verification systems solve this by instantly confirming insurance coverage, benefits and financial responsibility before services are delivered. These systems check coverage details, identify coordination of benefits issues and flag potential authorization requirements. Staff can address discrepancies immediately instead of discovering them weeks later.

Modern registration platforms integrate with your practice management system to eliminate manual data entry errors. Staff can scan insurance cards, automatically populate patient information and verify eligibility in seconds. When patients understand their financial obligations from the start, they’re more prepared to pay.

Get Coding and Claims Right

Medical coding accuracy directly determines how much you collect. The challenge is that coding requirements constantly change with new regulations, payer-specific rules and updated code sets. And incorrect codes trigger denials, create compliance risks and leave money on the table.

Catching errors before submission means cleaner claims, faster payments and less staff time spent on rework. AI-powered coding tools analyze clinical documentation and suggest appropriate codes based on payer knowledge. These systems identify documentation gaps, recommend queries to providers and flag potential compliance issues before claims go out.

Additionally, automated claims scrubbing tools check every claim against payer-specific rules before submission. They detect missing information, coding inconsistencies and billing errors that would otherwise trigger denials.

Turn Denial Management Into Revenue Recovery

Medicare Advantage plans saw denial rates spike 59% in 2024, while commercial payers also increased their rates. Common reasons include coding errors, medical necessity questions, authorization issues, missing information and timely filing violations.

Dedicated denial management teams analyze denial patterns to identify root causes. By tracking denials systematically and categorizing them by reason and payer, you develop targeted solutions.

Successful appeals require gathering supporting documentation, crafting medical necessity arguments and meeting strict filing deadlines. More than half of denied claims (54%) are eventually overturned, according to Premier Inc. data — making a robust appeals process essential.

Make Patient Payment Easier

More than half of American workers (55%) are enrolled in high-deductible health plans, meaning patients pay larger portions of their healthcare costs. This shift requires more transparent communication and flexible payment options.

Patients expect to understand their financial obligations before receiving care, and providing cost estimates upfront reduces surprise bills and improves satisfaction. When patients know what they’ll owe, they can make informed care decisions and plan for payment.

Patient self-service portals let patients view account balances, make online payments and set up payment plans at their convenience. Offering multiple payment methods, including credit card-on-file services, makes fulfilling financial obligations easier.

Point-of-service collections represent another critical strategy. Collecting copayments, deductibles and other patient responsibility at service time significantly improves collection rates.

Track What Matters

Days in accounts receivable measures collection speed. Industry standards suggest 30 days or less for high-performing practices and 40-50 days for average performers.

Net collection rate measures the percentage of collectible revenue you actually receive. This calculation factors out contractual adjustments and charity care. A declining rate signals problems with coding accuracy, denial management or collection processes.

Denial rate tracking provides insight into both initial denials and final denials after appeals. Clean claim rates should reach 95% or higher, measuring claims paid on first submission for optimal performance.

Invest in Your Team

Your revenue cycle team’s knowledge directly impacts financial performance. The healthcare billing environment constantly changes with new coding requirements, payer policy updates and regulatory modifications.

Regular training on coding updates ensures your team stays current with annual code changes, modifier usage and documentation requirements. Beyond technical skills, staff members need to understand payer-specific billing rules, prior authorization requirements and claim submission guidelines.

Cross-training creates flexibility and deepens organizational knowledge. When multiple staff understand each function, your practice better handles absences, turnover and volume fluctuations.

Know When to Get Help

Not every practice has resources to manage all revenue cycle aspects internally. Medium to large practices with satellite offices often find that outsourcing allows them to focus on patient care. The right partner brings knowledge of payer requirements, proven denial management strategies and technology platforms.

Some practices benefit from outsourcing specific functions like coding, credentialing or denial management while retaining other functions internally. Others prefer comprehensive outsourcing. The key is choosing an approach that addresses your specific challenges.

When evaluating potential partners, prioritize those with healthcare expertise, proven performance metrics and technology capabilities that integrate with your systems. Look for partners who provide transparency through regular reporting and analytics.

Strengthen Your Revenue Cycle

Rising denial rates, increasing patient financial responsibility, complex payer requirements and staffing pressures create a difficult operating environment. However, practices that take a strategic, systematic approach to revenue cycle management can protect their revenue and improve cash flow.

We specialize in identifying and fixing problems in medical billing workflows. Our healthcare professionals bring expertise to medical billing processes and revenue cycle management, delivering solutions that help healthcare clients decrease claim denials, improve payment and collections, reduce days in accounts receivable and improve your overall billing cycle. Contact a James Moore professional to learn how we can help strengthen your practice’s financial foundation.

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