Challenges Associated with RCM

Revenue Cycle Management
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Challenges Associated with RCM

Manley, R., &Satiani, B. (2009). Revenue cycle management. Journal Of Vascular Surgery50(5), 1232-1238.

Converting services rendered to revenue in a health care setting is critical for the survival and growth of any health organization. Businesses always have policies to collect account receivables. In the health care industry, there are formal actions to deal with monetary collections due to the complexity of the reimbursement systems. However, there exist challenges in revenue cycle management, as discussed in this article.

Getting accreditation from the payer has been an issue for providers. The payers must accredit physicians to receive payment. Some payers drag the process of crediting hospitals, resulting in hospitals attending to patients before approval from the payer. This can occasion denial from the payer resulting in free services rendered.

Hospitals also face the challenge of collecting deductibles from the patients. Upon registration at the hospitals, the facility should obtain financial information and obtain any required signatures to collect the payment. It has always been perceived that it would be inappropriate to ask for money from patients. However, people should pay for these services. Financial experts say the ability to collect bills diminishes as time passes. There should be a significant effort to collect the patient deductible at the time of service.

There is also a chance of missing numerous professional charges when billing the patients. This article gives consultations, office visits, and lab interpretations as services are likely to be missed by the billers in the case of vascular surgeons. When sending a bill, all information should be filled in to eliminate unnecessary delays.

Hospitals also face denial of payment from the payers. Claims should be paid promptly and correctly, but this is not always the case. Hospitals always work with third payers, who sometimes are reluctant to pay, especially for high-cost medical care. Sometimes, this denial is due to minor errors which can be quickly resolved.





Manley, R., &Satiani, B. (2009). Revenue cycle management. Journal Of Vascular             Surgery50(5), 1232-1238.