From back office to balance sheet: Why revenue cycle is becoming strategic AI infrastructure
Healthcare finance leaders are confronting a new reality: Revenue cycle performance now directly influences organizational stability, capital planning and access to care. Rising denial rates, expanding prior authorization requirements and persistent staffing constraints have transformed revenue operations from a transactional function into a strategic enterprise capability. Recent reporting from Kaufman Hall shows denials and revenue…
Optimizing the revenue cycle workforce: Balancing automation with empathy to elevate the patient experience
In today’s healthcare landscape, every financial conversation shapes not just patient satisfaction, but organizational trust. As health systems work to manage rising costs and operational complexity, revenue cycle teams find themselves carrying the dual burden of protecting financial performance while supporting patient experience, often without the resources to excel at either. Automation presents undeniable advantages…
Redefining healthcare financial KPIs in a post-COVID era: A strategic imperative
The COVID-19 pandemic compelled hospitals and health systems to rethink nearly every aspect of their operations. Nowhere was the disruption more profoundly felt than in the revenue cycle. Long-standing financial key performance indicators (KPIs) such as accounts receivable (AR) days, clean claim rates and denial percentages, quickly lost their relevance amid staffing shortages, unpredictable patient…
5 key strategies for a successful mid-cycle
Today’s mid-cycle teams face mounting pressure. Oversight is tightening, payer policies are shifting rapidly and margins continue to shrink. This phase is no longer a simple pass-through, it’s a vital operational checkpoint that demands both strategic leadership and attention to detail. Hospitals that implement structure and prioritize accuracy tend to stay ahead. Those that don’t…
Fortifying revenue management: The critical role of health information management in cybersecurity preparedness
A hospital’s health information management (HIM) team oversees the flow of patient care documentation in healthcare organizations, supporting accuracy, accessibility and security. In the revenue cycle, HIM maintains financial integrity by managing patient data, ensuring proper coding and documentation for billing and verifying clinical data for compliance and reimbursement. HIM also plays an active role…
5 keys to enhancing automation, expanding capacity and improving efficiency to reduce costs
Healthcare organizations face unrelenting financial pressures, with rising costs and shrinking margins. Dealing with reimbursement challenges, they face an uphill battle to maintain a profitable revenue cycle. This leaves no room for inefficiency. There is a way out, but healthcare leaders must look beyond traditional methods to automation to expand capacity and improve operational efficiency.
How AI and automation are revolutionizing revenue cycle operations for faster, more accurate reimbursement
Revenue cycle management (RCM) is a critical component of healthcare operations, yet providers face mounting challenges in ensuring timely and accurate reimbursements. Manual processes, evolving regulatory requirements and administrative inefficiencies contribute to revenue leakage and operational burdens. Traditional RCM processes are labor-intensive, relying heavily on manual billing, coding and claims submission. These inefficiencies not only…
How regulatory shifts are shaping the future of revenue cycle operations
The healthcare industry is set for a major transformation, driven by government policies, legislative reforms, insurance updates and a continuous evolution of compliance and privacy standards that impact revenue cycle management (RCM). These developments present both challenges and opportunities for RCM teams but embracing them is crucial for healthcare organizations to thrive. Key regulatory changes…
Navigating regulatory challenges in hospital revenue cycle: the impact on RCM teams and the path forward
The term “regulatory compliance” is often associated with its cost. However, the foundational purpose of regulations is to protect patients and ensure quality care. Most would agree a healthcare system without regulations would be catastrophic. But provider organizations are now burdened with managing compliance under increasingly complex requirements. If they fall short, they can expect…
5 revenue cycle management myths dispelled
The traditional healthcare revenue cycle was designed to evolve around payer reimbursement. Processes and workflows were pretty much set in stone. Step 1: register the patient; step 2: verify insurance and eligibility; step 3: capture the charges; step 4: code the claim, and so on. The lack of automation and interoperability solutions, especially electronic health…