Physician groups face a dynamic and fast-changing healthcare landscape that brings new challenges to their revenue cycle management (RCM) operations. Addressing these pain points—from preventing payer denials to adopting modern technologies—is critical to achieving ongoing financial stability and bringing operational excellence to RCM processes.
With the right strategy and RCM partner, you can transform challenges into opportunities for growth and success. This can help you improve RCM processes and overcome other issues that negatively impact cash flow.
4 physician group challenges—And how to solve them
A successful RCM consists of streamlined standard operational processes and achieves optimal financial results. Here are four common challenges to overcome for revenue cycle success:
1. Tackling bad payer behavior
Excessive denials and delayed reimbursements are among the biggest hurdles physician groups encounter. Slow payments not only disrupt cash flow but also increase administrative burdens.
You can combat these issues with proactive denial management tools, including rules engines aligned with payer requirements. By catching errors with pre-bill edits before claims are submitted, you can reduce rework, ensure cleaner claims and accelerate payment cycles.
Additionally, the growing responsibility for patients to make payments due to high-deductible plans complicates revenue collection. You can address this with patient-friendly solutions, such as online bill pay, text-to-pay options and automated reminders, helping improve collections and reduce bad debt.
Leveraging your key strengths, such as quality of care, patient volume and specialized services, can significantly improve your negotiation power with commercial payer contracts. This can help drive stronger financial results for your organization and complements your efforts to improve payer behavior.
2. Implementing proven staffing strategies
Staff shortages and turnover in RCM roles—trends that are becoming more prevalent—exacerbate inefficiencies, leading to delays in processing and potential costly mistakes. Workforce optimization paired with technology is key to overcoming these obstacles. We encourage physician groups to empower their staff with comprehensive training that focuses on the “why” behind each task, fostering critical thinking, enhancing employees’ understanding of the impact of their role, and reducing errors.
By using technology to automate repetitive processes for our clients—such as claim status checks and denial appeals—we enable our client’s RCM staff to focus on higher-value tasks that improve both morale and retention. This balanced approach optimizes workforce efficiency and builds a more engaged team.
3. Leveraging advanced analytics
The ability to analyze data is critical for pinpointing RCM bottlenecks and uncovering opportunities for improvement. Analytics can deliver targeted insights into payer behavior, staff performance and operational inefficiencies, paving the way for you to make impactful changes across your physician group.
With the right technology, you can visualize analytics, making them easily consumable. For example, we can develop custom dashboards that track critical metrics such as cash flow, AR days and denial rates. These dashboards present data in a user-friendly format, offering actionable insights to inform decision-making and optimize revenue cycle performance. We also offer proactive, real-time, exception-based business intelligence (BI) to “push” areas of focus to the appropriate process owners to address.
4. Using cutting-edge technology
The right technology is foundational to addressing RCM challenges and enhancing analytics capabilities. From unified data platforms to modern RCM solutions, you need advanced tools to stay ahead.
Innovative technologies, including AI and automation, streamline essential tasks such as predicting denials, generating appeal letters, retrieving medical records and verifying patient eligibility. These technologies improve efficiency, reduce administrative burdens and maximize cash flow. For instance, the R1 Platform uses AI, intelligent automation and deep data analytics to turn complex data into actionable insights, driving financial and operational excellence.
Case Study: What’s possible with a collaborative approach
We partnered with an organization facing excessive denials and achieved significant results over five years:
- 80% increase in net revenue
- 73% increase in gross revenue
- 21% reduction in AR days
- Improved patient experiences
With a focus on analytics, technology and collaboration, the client was able to address challenges strategically. As a result, the organization transformed its revenue cycle operations, achieving sustained financial and operational success—even through the COVID-19 pandemic.
Seize new and emerging opportunities
You have the opportunity to optimize cash flow by tackling payer challenges, empowering staff, and embracing advanced analytics and technology. R1 partners with physician groups to provide proven RCM expertise and innovative solutions tailored specifically to individual needs. We also have the expertise to provide insights into industry trends and best practices and offer proven revenue cycle strategies for stronger financial outcomes.
We enable physician groups to focus on delivering quality patient care while navigating the complexities of RCM. By adopting modern tools and strategies, you can enhance efficiency, improve financial outcomes and seize new opportunities for growth.
For more insights, check out our on-demand webinar “How Physician Groups are Accelerating Revenue Cycle Results” here.
Immediate actions for physician groups to take
To achieve accelerated revenue cycle results, you should consider these immediate actions:
- Audit denial trends. Identify recurring issues and deploy pre-bill edits to reduce denials.
- Invest in staff training. Create programs that teach the rationale behind RCM tasks to improve efficiency and accuracy.
- Take advantage of automation. Start small with targeted workflows, such as claim status checks or denial scrubbing.
- Unleash analytics. Use dashboards to track key performance indicators (KPIs) and identify opportunities for improvement.
How R1 partners with your physician practice
R1 is a leading provider of revenue cycle and contract management solutions. Our experts work with physician practices in all 50 states and have experience serving more than 70 physician specialties. Reach out to R1 today to discuss how we can help you tackle your tough RCM challenges.
Author: Robert Troksa
Robert Troksa is the Vice President/GM Office Based Physician Services at R1. He and his team partner with Independent Physician Groups across all aspects of RCM: Front, Middle and Back. He has 30+ years of extensive experience navigating complex, cross-functional environments in Physician RCM.
