Revenue cycle management (RCM) is meant to be the financial backbone of healthcare. But for many organizations, it’s become a constant source of friction. Between rising denial rates, disconnected systems, and payer rules that shift without warning, every billing cycle feels like a scramble.
Roughly one-third of U.S. healthcare centers now operate on negative margins, and much of that strain traces back to revenue cycle inefficiencies. According to McKinsey, 15% of initial claims were denied in 2023, up from just 9% in 2016. That kind of trend puts added pressure on already stretched staff, who still rely on a patchwork of spreadsheets, emails, and manual workarounds to keep cash flowing.
The cost isn’t just financial. Delayed payments slow operations, contribute to staff burnout, and quietly introduce compliance risk across the organization.
In this article, we break down real-world revenue cycle management challenges and show how health systems are addressing them, not through full system overhauls, but by identifying weak links and improving workflows with the right tools.
Revenue cycle management (RCM) is the financial backbone of any healthcare organization. At its core, RCM governs how and when providers are reimbursed for the care they deliver. The process begins before a patient is even seen and continues well past the encounter, tracking every action tied to billing, coverage, compliance, and collection.
A complete RCM cycle typically includes:
This isn’t new. What’s changed is how complex every step has become.
Healthcare organizations are now expected to manage rising patient deductibles, rapidly shifting payer requirements, and staff shortages, all while using systems that often weren’t designed to work together. Many billing teams still toggle between EHR screens, clearinghouse portals, Excel spreadsheets, and legacy databases to submit a single claim.
The financial pressure isn’t theoretical. It shows up daily:
Even well-run organizations are struggling to keep up. According to a 2024 survey published by TechTarget, 68% of revenue cycle leaders stated that their current systems don’t support proactive denial prevention strategies, and more than half reported that payer communication delays are at an all-time high.
What used to be handled with extra hours and manual follow-up has reached a tipping point. Without coordinated systems and more intelligent workflows, RCM is no longer sustainable.
Revenue cycle issues often begin before a claim is ever generated. Patient intake, the first step in the RCM workflow, is where a significant amount of revenue leakage often begins.
Incomplete demographic details, insurance mismatches, or unverified coverage can trigger downstream delays, claim rejections, or lost reimbursements. When front-office teams rely on manual data entry or disconnected forms, it’s only a matter of time before something slips through.
These gaps show up in subtle ways:
Each of these seems small, but at scale, they create costly denials and slow down revenue realization.
A stronger intake process isn’t about adding more staff — it’s about making the workflow easier for everyone involved.
That means:
When we worked with an elderly care platform, intake challenges were a top priority. The product included a user-friendly patient app that prompted device readings and appointment tasks but just as important was the web-based portal for care teams. It allowed staff to view upcoming appointments, confirm benefit coverage in advance, and keep intake requirements on track without relying on email threads or separate spreadsheets.
By aligning intake documentation with clinical and billing views, the elderly care platform improved claim accuracy and reduced administrative burden, particularly for patients with high-touch care needs.
Related read: Revenue Cycle Management in Medical Billing
For providers, confirming whether a service is covered — and whether it needs prior authorization — has become one of the most frustrating parts of the billing process.
Even when eligibility appears “active,” that doesn’t always mean a claim will be paid. Plan-specific exclusions, narrow authorization windows, and complex benefit tiers make coverage anything but straightforward. Miss one detail, and a clean claim quickly becomes a denial.
What this looks like on the ground:
A 2024 McKinsey analysis highlighted just how much this burden has grown:
Physicians now handle an average of 45 prior authorization requests per week, and each manual request costs between $6 and $11 in administrative expense.
In many cases, these denials could have been avoided — if eligibility had been confirmed earlier or if the prior auth process wasn’t buried in faxes and phone calls. The process is slow, error-prone, and costly.
In a podcast I recently watched titled “America’s $5 Trillion Healthcare Scam” by Farzad Mesbahi, the conversation broke down the staggering cost of administrative waste in U.S. healthcare — over 30% of healthcare spending, compared to just 2% under Medicare. That translates to more than $400 billion lost annually to inefficiencies such as:
One of the most alarming stats: physicians now spend over 2 hours on admin work for every hour of clinical care, often dealing with a sea of 1,300+ unique insurance forms.
This isn’t just a physician problem. It puts immense pressure on billing teams, who must manually track authorizations, navigate payer-specific timelines, and reconcile disparate systems, often without full visibility into what has been approved or denied.
According to a survey by the American Medical Association,
Manual, reactive workflows are no longer sustainable. The administrative burden is costing time, money, and in some cases, patient safety.
In a recent project utilizing a remote monitoring platform, the care team required more than just a means to track vitals. They needed a connected system that could validate device eligibility and usage authorization in real time.
We implemented a workflow that automatically notified care managers when coverage issues were flagged and ensured documentation aligned with CPT coding requirements for billable services. This significantly reduced reimbursement delays — but more importantly, it gave clinical teams the ability to focus on care instead of chasing paperwork.
A key part of this solution was InsureVerify AI — a workflow designed to automate insurance eligibility checks, authorization tracking, and benefit validations. It helps surface payer-specific flags before services are rendered, so billing doesn’t become reactive. For care teams and administrative staff alike, it provides the right information at the right time, with fewer follow-ups and fewer denials.
Even when eligibility is confirmed and the service is delivered, the claim is far from guaranteed to be paid. A large percentage of denials come down to documentation gaps, incorrect codes, or billing misalignment.
According to Experian Health’s 2024 claims report, the top denial triggers are:
These aren’t always major errors. A small typo in demographic info or a missed modifier can push a clean claim into denial status.
In fact, over one-third of healthcare finance staff say at least 10% of their claims are denied, and 11% report denial rates over 15%. Authorization lapses are a recurring issue — failing to obtain pre-approval often guarantees a denial. And keeping up with payer policies has become harder: 77% of RCM teams say payer rules change more frequently now, up from 67% in 2022.
As Clarissa Riggins, Chief Product Officer at Experian Health, put it:
“We had hoped to see a decrease in claim denials… but it’s clear these challenges are continuing, adding immense pressure on providers to improve their RCM processes.”
These problems are rarely intentional. Most providers are working within the limits of fragmented systems and shifting payer expectations.
What this looks like in practice:
Each denial means extra follow-up, delayed revenue, and added administrative cost. Multiply that by hundreds or thousands of claims, and the impact is felt across the entire organization.
The path forward doesn’t lie in more manual checks. AI-powered workflows can help flag claims likely to be denied, based on payer history, documentation trends, and code patterns, before they go out the door. That means fewer reworks, cleaner submissions, and faster reimbursement.
Most billing teams operate downstream from the clinical encounter. If documentation is unclear or codes are selected manually without validation, there’s little opportunity to correct issues before submission. Many EHRs also lack built-in coding intelligence that aligns with payer-specific requirements.
Staff turnover and variable coding training also contribute to this issue. Even experienced coders can miss details when they rush to keep up with high volumes or switch between specialties.
In a project involving a clinical decision support platform, one of the early challenges was bridging the gap between clinical documentation and billing requirements. While the system offered personalized test recommendations, the interface didn’t clearly show how provider inputs translated into billable logic.
We redesigned the front-end experience to create a clear link between clinical actions and backend rules, ensuring each test recommendation could be tied to appropriate codes and justification. Configurable test guidelines were also introduced to allow quick adaptation as payer policies evolved.
The result was more consistent claims, fewer manual edits, and a smoother feedback loop between clinical and billing teams.
Related read: Remote Patient Monitoring Billing Guidelines For Healthcare Providers – CPT Codes, Reimbursement & Compliance
When clinical and billing systems fail to communicate with each other, revenue takes a hit. Many organizations still operate with fragmented platforms — one for documentation, another for scheduling, and yet another for billing. That separation leaves critical information delayed, duplicated, or completely missing.
This kind of fragmentation leads to:
Unfortunately, inaccuracies remain common. Some industry experts estimate that up to 80% of medical bills contain errors of some kind — from coding mistakes and incorrect patient details to missing authorization or the wrong insurance ID numbers.
These errors don’t just delay payments — they often lead to outright denials or rejections. And the issue is only getting worse. In a recent survey reported by Becker’s Hospital Review, 55% of healthcare finance staff said claim errors are increasing, up from 43% the previous year.
When clean claims rely on manual reconciliation between disconnected systems, accuracy becomes a moving target, and billing teams are stuck cleaning up problems they didn’t create.
Integrating systems sounds straightforward on paper, but in practice, it’s complicated. Many legacy EHRs do not offer modern APIs or use inconsistent data formats. Billing vendors may operate independently and require custom work to synchronize data in real-time. For most teams, integration projects take a backseat to immediate billing needs, even if the lack of integration is creating daily inefficiencies.
For one of our long-term partners, we implemented a unified care manager portal that consolidated data from remote monitoring devices, care plans, and appointment scheduling into a single system. To make this possible, we used HealthConnect CoPilot — a modular interoperability framework designed to sync data across EHRs, scheduling tools, and billing systems.
Built with native support for HL7 and FHIR, the platform ensured real-time alignment between clinical activity and financial workflows. Instead of relying on manual exports or waiting for report reconciliations, billing teams had direct visibility into patient data, CPT codes, and coverage status — all in one place.
This closed the loop between care delivery and reimbursement, giving staff the tools to act on clean, complete data without disrupting workflows. The results were clear: faster claim submissions, fewer errors, and significantly less time spent chasing documentation.
Struggling with disconnected systems and manual reconciliation?
Discover how HealthConnect CoPilot can help unify your EHR, billing, and scheduling workflows through secure, FHIR-ready integration, all without disrupting your existing technology stack.
Even the most organized billing teams struggle to keep up with the constant changes in payer policies. Each payer has its documentation requirements, coding interpretations, and reimbursement schedules. What works for one plan may get rejected by another.
These inconsistencies lead to:
This variability makes it hard to standardize billing practices. Teams often resort to payer-specific cheat sheets or rely on institutional memory, which is unsustainable as staff turnover increases.
Without a centralized system to track payer behavior and apply those insights across workflows, teams are constantly playing catch-up. When reimbursement rules change without warning or payer portals update without notice, delays and denials are inevitable.
Over time, these small inconsistencies chip away at revenue, especially when no system exists to flag patterns early or automate payer-specific workflows.
In collaboration with a medical device provider, the organization required more than a standard dashboard; they needed a data infrastructure capable of delivering actionable insights across device usage, testing activity, and regional performance. We developed a Power BI-based analytics system that tracked clinical metrics and revealed trends in payer behavior and reimbursement outcomes across different territories.
By creating filtered views based on payer behavior and enabling drill-down capabilities, we helped the team identify recurring denial reasons, adjust workflows, and engage in data-backed conversations with their billing partners.
The result was better visibility, fewer surprises, and a more proactive approach to managing claims across a fragmented payer landscape.
Behind every clean claim is a staff member doing the heavy lifting, verifying coverage, correcting documentation, following up on denials, and closing out balances. When systems are fragmented and tasks are manual, this work becomes repetitive and overwhelming.
Teams often operate in reactive mode, moving from one issue to the next with limited visibility into what’s coming. Over time, this leads to:
The burden isn’t just operational. Burnout among revenue cycle teams affects morale across departments and creates ripple effects that impact everything from reimbursement to compliance.
There’s valid concern around automation in billing, especially when teams are already stretched thin. But the goal isn’t to replace people. It’s to reduce the manual, repetitive work that slows them down.
Tasks such as tracking documentation, flagging missing codes, and generating appeal packets can be automated, allowing staff to focus on exceptions rather than status checks. When automation handles the routine, your team can focus on resolving complex issues faster.
As Adam Robinson, VP of Platform Engineering at FinThrive, noted in an interview with HealthTech Magazine:
“Our customers are under constant pressure in terms of their costs and being able to recover costs from insurance carriers… Being able to take advantage of machine learning and AI to make people more efficient is a big area for us.”
– HealthTech Magazine
The shift isn’t about removing people. It’s about giving them better tools to move from firefighting to planning.
In one project focused on optimizing diagnostic workflow, care teams struggled to manage evolving test guidelines across multiple specialties. The platform needed to accommodate custom rules that providers could update independently, without adding an administrative burden.
To solve this, we built a centralized dashboard where guideline logic could be visually reviewed and edited. This gave teams the ability to make real-time adjustments without relying on engineering. By eliminating the need for backend changes and reducing reliance on email threads or manual documentation, the workflow became more collaborative, efficient, and responsive to real-world RCM needs.
As more financial responsibility shifts to patients, collecting balances has become one of the most difficult parts of the revenue cycle. High-deductible health plans, limited payment transparency, and billing delays create confusion for patients and financial challenges for providers.
Common issues include:
For many patients, the first bill is also the last communication they receive. Without reminders or flexible payment options, balances often remain unpaid and are eventually written off.
Collections teams often rely on phone calls, mailed statements, or manual outreach spreadsheets to follow up on outstanding accounts. These processes are time-consuming and inconsistent. With limited insight into patient preferences or responsiveness, efforts are often misdirected.
Missed collections not only affect revenue but also damage the patient relationship. A confusing or aggressive billing experience can erode trust built during the care journey.
In a recent project involving a remote care coordination platform, part of the focus was improving billing transparency through a shared portal used by both care teams and administrative staff. The system enabled users to identify patients with overdue readings or unresolved billing events and take follow-up actions directly within the same interface used for daily care operations.
Because care teams already had an established relationship with patients, bringing billing into their workflow made the outreach feel more familiar and timely. Combined with structured reminders and clear dashboards, this approach led to faster responses and improved engagement on both the clinical and financial sides.
The key was not just automating follow-up, but ensuring it came from the right person at the right time, with access to the right context.
Revenue cycle problems are often viewed through a financial lens, but many of them are also compliance risks in disguise. When documentation is incomplete, data is shared across insecure channels, or audit trails are missing, organizations become vulnerable to penalties that go beyond claim rejections.
Common compliance pitfalls tied to RCM include:
These issues can trigger HIPAA violations, payer audits, or revocation of billing privileges, each carrying serious consequences.
In fast-paced environments, compliance often gets treated as a checkbox instead of an active process. Teams may store data in shared drives or rely on spreadsheets to track protected information. And because billing and clinical systems are usually managed by separate departments, access controls and monitoring are inconsistent.
The cost of non-compliance is not limited to fines. It can delay payments, damage reputation, and create roadblocks to participating in payer networks.
When we worked with the team behind BirthModel, ensuring security and compliance was not just a technical requirement; it was a business necessity. The platform uses predictive analytics in labor and delivery care and integrates directly with EHR systems like Epic.
To meet HIPAA and SOC 2 requirements, we implemented Vanta’s automated monitoring solution. This allowed the team to track user activity, set access controls, and maintain real-time compliance dashboards, reducing manual audit prep and ensuring readiness for reviews at any time.
The process was designed to be embedded into day-to-day operations. Compliance became a system behavior, not just a checklist.
When revenue cycle operations falter, the financial consequences are immediate. However, the ripple effects often extend beyond clinical workflows, patient satisfaction, and overall organizational stability.
Delayed or denied payments can result in:
From the patient’s perspective, a flawed revenue cycle experience can erode trust. Confusing bills, surprise balances, and slow responses to questions create barriers to ongoing care. In some cases, patients may delay or avoid treatment altogether due to financial uncertainty.
Clinical teams are not immune to revenue cycle problems. When prior authorizations are missed or claims are denied retroactively, providers may need to adjust their treatment plans or revisit previously approved procedures. That puts stress on both staff and patients, especially when financial outcomes become tied to quality metrics.
In environments transitioning to value-based care, disjointed RCM processes can hinder organizations from meeting their targets. Denials, missed charges, and slow collections make it harder to track outcomes or reinvest in quality initiatives.
RCM should not be treated as a backend task. It is a foundational part of the care experience, and when it breaks, everything downstream suffers.
Fixing revenue cycle management doesn’t mean rebuilding everything. Most of the time, the problems are known, but the path to resolution is unclear or spread across too many disconnected systems.
If you’re seeing frequent denials, delayed reimbursements, or rising administrative workload, here’s where to start:
Improvements don’t have to be massive. They must be deliberate and fit seamlessly into your current operations without overwhelming your team. The right workflows customized to your environment can make RCM more predictable, accurate, and less reactive.
Before fixing anything, it helps to know what “working” should look like. Below is a simple checklist to evaluate how your current revenue cycle process stacks up.
Is your RCM workflow meeting these benchmarks?
If you checked fewer than seven items, there’s likely room for improvement. The good news is that most of these gaps can be addressed without overhauling your system — it starts with streamlining the workflows behind them.
Revenue cycle management problems rarely have a one-size-fits-all fix. Systems, staff structures, and payer mixes vary, and the solution must account for all of them. That’s why at Mindbowser, we don’t just plug into your systems — we adapt to them.
Every RCM workflow we support begins with a 40% pre-engineered foundation, refined over the years through our work with healthcare organizations. The remaining 60% is customized to your processes, whether that means integrating with a legacy EHR, aligning with unique billing rules, or simplifying documentation for specialty care.
We focus on building workflows that eliminate handoffs, reduce denial risk, and improve payment timelines — without introducing technical debt or requiring a full system overhaul.
These workflows were designed to solve the exact challenges covered in this blog: intake errors, delayed authorizations, claim denials, disconnected systems, and payment gaps. And they’ve already helped organizations move from reactive clean-up to proactive RCM control without overhauling their entire infrastructure.
Revenue cycle management challenges are not new, but they’ve become harder to ignore. With tighter margins, evolving payer rules, and increasing patient financial responsibility, small inefficiencies now lead to significant revenue loss.
Solving these challenges isn’t about adopting flashy tools. It’s about building workflows that work for your staff, your systems, and your patients. From intake to payment posting, each step in the revenue cycle should feel connected, compliant, and manageable.
At Mindbowser, we’ve helped healthcare organizations address these problems without ripping out what already works. By layering targeted workflows that enhance intake, coding, billing, and follow-up, we’ve seen teams reduce denials, shorten reimbursement cycles, and free up time for what matters most: delivering care.
The most common challenges include claim denials, eligibility verification issues, disconnected billing systems, manual intake processes, and inconsistent patient collections. These problems often result in delayed payments and increased administrative burdens.
Providers can reduce denials by verifying insurance coverage before appointments, aligning documentation with coding requirements, and utilizing real-time alerts to flag missing or incorrect information prior to claim submission.
Prior authorizations are often handled manually, leading to delays and missed approvals. Without a system to track and automate this step, services may be delivered before approvals are confirmed, increasing the risk of denied claims.
When EHR and billing systems don’t sync, documentation and charge capture become inconsistent. This results in coding errors, claim rework, and revenue loss due to the absence or delay of critical information.
Offering digital payment options, sending automated reminders, and presenting clear, itemized bills can improve patient payment rates. It’s also important to communicate financial responsibilities upfront during the scheduling or intake process.
Join us for “Your 24/7 Clinical Knowledge Partner – The AI Companion For Nurses” Webinar on Wednesday, 30th July 2025 at 11:00 AM EDT
Register Now
We worked with Mindbowser on a design sprint, and their team did an awesome job. They really helped us shape the look and feel of our web app and gave us a clean, thoughtful design that our build team could...
The team at Mindbowser was highly professional, patient, and collaborative throughout our engagement. They struck the right balance between offering guidance and taking direction, which made the development process smooth. Although our project wasn’t related to healthcare, we clearly benefited...
Founder, Texas Ranch Security
Mindbowser played a crucial role in helping us bring everything together into a unified, cohesive product. Their commitment to industry-standard coding practices made an enormous difference, allowing developers to seamlessly transition in and out of the project without any confusion....
CEO, MarketsAI
I'm thrilled to be partnering with Mindbowser on our journey with TravelRite. The collaboration has been exceptional, and I’m truly grateful for the dedication and expertise the team has brought to the development process. Their commitment to our mission is...
Founder & CEO, TravelRite
The Mindbowser team's professionalism consistently impressed me. Their commitment to quality shone through in every aspect of the project. They truly went the extra mile, ensuring they understood our needs perfectly and were always willing to invest the time to...
CTO, New Day Therapeutics
I collaborated with Mindbowser for several years on a complex SaaS platform project. They took over a partially completed project and successfully transformed it into a fully functional and robust platform. Throughout the entire process, the quality of their work...
President, E.B. Carlson
Mindbowser and team are professional, talented and very responsive. They got us through a challenging situation with our IOT product successfully. They will be our go to dev team going forward.
Founder, Cascada
Amazing team to work with. Very responsive and very skilled in both front and backend engineering. Looking forward to our next project together.
Co-Founder, Emerge
The team is great to work with. Very professional, on task, and efficient.
Founder, PeriopMD
I can not express enough how pleased we are with the whole team. From the first call and meeting, they took our vision and ran with it. Communication was easy and everyone was flexible to our schedule. I’m excited to...
Founder, Seeke
We had very close go live timeline and Mindbowser team got us live a month before.
CEO, BuyNow WorldWide
Mindbowser brought in a team of skilled developers who were easy to work with and deeply committed to the project. If you're looking for reliable, high-quality development support, I’d absolutely recommend them.
Founder, Teach Reach
Mindbowser built both iOS and Android apps for Mindworks, that have stood the test of time. 5 years later they still function quite beautifully. Their team always met their objectives and I'm very happy with the end result. Thank you!
Founder, Mindworks
Mindbowser has delivered a much better quality product than our previous tech vendors. Our product is stable and passed Well Architected Framework Review from AWS.
CEO, PurpleAnt
I am happy to share that we got USD 10k in cloud credits courtesy of our friends at Mindbowser. Thank you Pravin and Ayush, this means a lot to us.
CTO, Shortlist
Mindbowser is one of the reasons that our app is successful. These guys have been a great team.
Founder & CEO, MangoMirror
Kudos for all your hard work and diligence on the Telehealth platform project. You made it possible.
CEO, ThriveHealth
Mindbowser helped us build an awesome iOS app to bring balance to people’s lives.
CEO, SMILINGMIND
They were a very responsive team! Extremely easy to communicate and work with!
Founder & CEO, TotTech
We’ve had very little-to-no hiccups at all—it’s been a really pleasurable experience.
Co-Founder, TEAM8s
Mindbowser was very helpful with explaining the development process and started quickly on the project.
Executive Director of Product Development, Innovation Lab
The greatest benefit we got from Mindbowser is the expertise. Their team has developed apps in all different industries with all types of social proofs.
Co-Founder, Vesica
Mindbowser is professional, efficient and thorough.
Consultant, XPRIZE
Very committed, they create beautiful apps and are very benevolent. They have brilliant Ideas.
Founder, S.T.A.R.S of Wellness
Mindbowser was great; they listened to us a lot and helped us hone in on the actual idea of the app. They had put together fantastic wireframes for us.
Co-Founder, Flat Earth
Mindbowser was incredibly responsive and understood exactly what I needed. They matched me with the perfect team member who not only grasped my vision but executed it flawlessly. The entire experience felt collaborative, efficient, and truly aligned with my goals.
Founder, Child Life On Call
The team from Mindbowser stayed on task, asked the right questions, and completed the required tasks in a timely fashion! Strong work team!
CEO, SDOH2Health LLC
Mindbowser was easy to work with and hit the ground running, immediately feeling like part of our team.
CEO, Stealth Startup
Mindbowser was an excellent partner in developing my fitness app. They were patient, attentive, & understood my business needs. The end product exceeded my expectations. Thrilled to share it globally.
Owner, Phalanx
Mindbowser's expertise in tech, process & mobile development made them our choice for our app. The team was dedicated to the process & delivered high-quality features on time. They also gave valuable industry advice. Highly recommend them for app development...
Co-Founder, Fox&Fork
