Revenue cycle management has become one of the most mission-critical—and most strained—functions in healthcare. In this episode, we unpack why rising patient responsibility, high-deductible health plans, slow insurance payments, and manual workflows are creating a perfect storm for practices.

We break down the six stages inside revenue cycle management, revealing where revenue leaks occur and how small breakdowns quickly turn into delayed payments, staff burnout, aging A/R, and lost revenue. We explore why traditional, people-powered billing processes can’t scale—and how automation, visibility, and flexible payment options are transforming the way practices get paid.

From pre-visit cost transparency and multi-channel billing to automated reminders, payment plans, financing, and integrated collections, we show how modern RCM systems help practices stabilize cash flow, reduce administrative burden, and deliver a better patient experience. If your team is still chasing payments manually, this episode explains why automation is no longer optional—it’s essential.

Transcript

Narrator: 00:00

Welcome to the Billing Blueprint Podcast, your go to resource for innovative medical billing solutions. Each episode we explore the latest industry trends and share proven strategies to help your practice streamline operations and get paid faster. Now here are your hosts, Brad and Sarah.

Sarah: 00:22

 Welcome back to the Deep Dive. Today we're opening up the financial control center of the healthcare world.

Brad: 00:28

 Revenue cycle management, or RCM as you'll hear it called.

Sarah: 00:32

 Right, RCM. And it's the absolute bedrock that determines whether a practice actually gets paid accurately and on time for the care they provide.

Brad: 00:41

 Exactly. It sounds like simple bookkeeping, but for so many practices right now, the system is under, well, just immense strain.

Sarah: 00:49

 We dove into a whole stack of sources that really map out the entire RCM process end to end. And maybe more importantly, why this issue is so urgent right now.

Brad: 01:00

 Yeah, it is. I mean, you got rising patient debt, you've got crippling administrative burnout.

Sarah: 01:04

 So our mission in this Deep Dive is to, is to really decode that chaos. We're going to break down the RCM process stage by stage so you can see exactly where the revenue leaks are happening.

Brad: 01:14

 And then we'll get into how modern automated systems are designed to plug those leaks for good.

Sarah: 01:19

 Because right now, providers are fighting what some sources are calling a perfect storm.

Brad: 01:24

 That's a good way to put it.

Sarah: 01:25

 Patient financial responsibility has just hit an all-time high, which is a direct result of the rise in high-deductible health plans. Yeah, and that's on top of slow insurance payments, constant coding changes, and, you know, patients who expect a seamless digital.

Brad: 01:40

 Experience, the same experience they get everywhere else. Fundamentally, RCM is the whole pipeline. It's the administrative and the clinical functions used to capture the, manage and collect revenue.

Sarah: 01:52

 So if that pipeline gets choked up.

Brad: 01:54

 At any point, the whole operation becomes financially unstable fast.

Sarah: 01:58

 And that structural shift is really why RCM has moved from this, like, quiet back-office task to maybe the single most mission critical function in healthcare finance today.

Brad: 02:08

 The biggest shift, without a doubt, is that HDHP phenomenon. Over the last decade, these plans have just soared in popularity and they've shifted.

Sarah: 02:16

 The financial burden dramatically.

Brad: 02:17

 Completely. We're not talking about a $20 copay anymore. Now, patients often owe thousands of dollars before their insurance even really kicks in.

Sarah: 02:26

 Which completely changes the collection model for a practice.

Brad: 02:29

 Right. It's not just about billing the insurer efficiently now, it's about collecting these big high dollar amounts directly from the patient. The practice basically has to become its own collections agency.

Sarah: 02:40

 And that's where the pressure really starts to build.

Brad: 02:42

 Oh, absolutely. Because not only are you chasing patients for more money, but the insurance companies are squeezing practices too. Reimbursement rates are dropping. Prior authorizations are a nightmare, a total administrative nightmare. And payment timelines have stretched out. What used to be a 30 day payment cycle is now pushing 60, sometimes 90 days.

Sarah: 03:03

 90 days? I mean, when you're trying to pay staff and keep the lights on in real time, that creates massive cash flow problems.

Brad: 03:10

 And that's just the financial cost. The human cost is huge.

Sarah: 03:13

 How so?

Brad: 03:14

 Well, when collections just meant, you know, a simple copay, the staff workload was pretty minimal. Now they're forced into these really emotionally uncomfortable money conversations day in and day.

Sarah: 03:25

 Out, chasing down balances for hundreds or even thousands of dollars.

Brad: 03:29

 Exactly. And that leads directly to the core operational problem. Administrative burnout. High staff turnover.

Sarah: 03:36

 Because the work itself is exhausting.

Brad: 03:38

 When it's all manual, it is printing statements, stuffing envelopes, manually entering charges, making endless phone calls. And when your best, most knowledgeable staff burn out and leave, the RCM problem just gets worse.

Sarah: 03:51

 Because the new team has to learn everything from scratch.

Brad: 03:54

 Right? And the cost of ignoring all of this is, well, it's direct financial damage. You get lost revenue from charges that just fall through the cracks. They never even get billed.

Sarah: 04:03

 Your accounts receivable starts to age out.

Brad: 04:05

 And once a balance hits 90 days, the chance you'll ever collect, it just drops off a cliff. So you're left with chaotic cash flow and frustrated patients who just ignore confusing bills.

Sarah: 04:16

 So to really get a handle on this, you have to visualize the whole process. Our sources describe it perfectly as a relay race.

Brad: 04:22

 I love that analogy.

Sarah: 04:24

 There are six essential stages, and if you drop the baton at any point, even a small mistake, the entire cycle slows down. It costs time, energy, and, of course, money.

Brad: 04:34

 The analogy works because it really emphasizes speed and accuracy. So let's walk through the six stages of this financial relay.

Sarah: 04:42

 Okay, stage one, patient registration and insurance verification. This is the starting line, the upfront check.

Brad: 04:48

 The goal here is just collecting accurate demographic info and verifying their insurance coverage before the service happens.

Sarah: 04:56

 This has to be the cheapest place to catch a denial.

Brad: 04:58

 It is by far. If the verification is flawed, you know, a misspelled name, an old policy, the claim gets rejected weeks, maybe months later. Then your staff has to backtrack and fix an issue that would have taken seconds to prevent.

Sarah: 05:12

 Okay, so after that, stage two is coding and charge. Capture the translation phase, right?

Brad: 05:17

 This is where you translate the medical services into the specific codes the payer will accept.

Sarah: 05:22

 And errors here Hit your bottom line immediately.

Brad: 05:25

 Instantly, you've got compliance risks like upcoding, which is charging for more expensive service than what was performed. Or the more common mistake is incorrectly unbundling services.

Sarah: 05:35

 Can you explain unbundling? That sounds like a really specific error.

Brad: 05:38

 It is. Unbundling is when you charge for two separate procedures when they really should have been billed together as one single service under one code. It's an easy mistake to make, but it's a huge red flag for the payer. It triggers scrutiny, review, and, you know, denial.

Sarah: 05:55

 Stage three, claim submission and follow up. The goal here is submitting what's called a clean claim.

Brad: 06:02

 A clean claim means you did your job perfectly. It gets processed, it gets paid. A dirty claim means something was wrong, a bad code, missing info, and that.

Sarah: 06:11

 Claim just bounces right back.

Brad: 06:12

 It bounces back and you have to manually fix it and resubmit it, which delays your payment by another 30 to 60 days. It's a huge cash flow killer.

Sarah: 06:20

 Okay, stage four, patient billing and statements. This is where the relay baton gets passed from the insurer to the patient.

Brad: 06:27

 And this is where most of the modern friction happens. Once the insurer pays their part, the patient gets the bill. But if that invoice is confusing or it arrives weeks late, or the payment options are terrible, the chances of you.

Sarah: 06:39

 Getting paid go way down.

Brad: 06:40

 Way down. Patients who don't understand the bill or find it inconvenient to pay, they just set it aside and forget about it.

Sarah: 06:48

 Which leads to stage five, payments and collections. This requires consistent, structured follow-up.

Brad: 06:54

 Right. If you're just relying on staff to get around to it, that revenue is just going to slip away.

Sarah: 06:59

 And finally, stage six, reporting and performance tracking. This is about closing the loop.

Brad: 07:05

 It's all about visibility. You have to track your key metrics, Arkansas days denial rates. It lets you stop guessing what the problem is and start solving it with actual data.

Sarah: 07:14

 That makes sense. Yeah, but why are so many practices still getting stuck at that Stage four, the patient billing part. What's keeping them chained to these old manual processes?

Brad: 07:24

 It really boils down to an inability to scale. They're relying on people for tasks that are just inherently repetitive.

Sarah: 07:31

 The printing, the stuffing envelopes, manually matching payments, all of it.

Brad: 07:35

 It's a massive time sink that just guarantees mistakes will be made.

Sarah: 07:38

 And crucially, there's no visibility. When you mail a statement, you have no idea if the patient even got it. Did they open it? Did they just toss it?

Brad: 07:45

 You're flying blind. You're just guessing which accounts need a follow up call. And that's on top of having disconnected systems.

Sarah: 07:51

 Yeah.

Brad: 07:51

 If your billing software doesn't talk to your payment processor and data just falls through the cracks.

Sarah: 07:56

 Okay, so given all those challenges, the manual work, the lack of visibility, the staff burnout, what are the practices who are actually getting this right? What are they doing differently?

Brad: 08:05

 They recognize that the solution isn't just to hire more billers, it's to work smarter. The modern solution is this combination of automation plus flexibility.

Sarah: 08:15

 Automation for the repetitive tasks and flexibility for the patient.

Brad: 08:18

 Exactly. Automation improves your billing accuracy and makes sure no follow up ever gets missed. And it speeds up the entire cycle. And the flexibility piece, that's what gets you paid in this new world of high patient responsibility.

Sarah: 08:31

 So let's run through that relay race one more time. But this time let's look at how automation and these integrated solutions can plug the leaks at each stage.

Brad: 08:39

 Great idea. Let's start at the beginning with pre visit financial clarity. The goal is to get rid of that sticker shock before the patient even gets care.

Sarah: 08:48

 How does that work?

Brad: 08:49

 Well, a solution like prebill lets the practice send a link via text or email a few days before the appointment. The patient can then go to a secure portal like paywoot, see a clear estimate of what they'll owe, and even pay early.

Sarah: 09:03

 That's a huge psychological shift. You're taking that awkward money conversation away from the front desk. So after the visit, automation takes over bill delivery.

Brad: 09:13

 And the multichannel approach is key for most people. You send an E bill a secure text or email and that links right to the payment portal. It's sent the same day the charge is created.

Sarah: 09:24

 No more week long mail delay.

Brad: 09:25

 Exactly. And for patients who still need paper, you can send professional mailed statements, often with a QR code on them to encourage a quick online payment.

Sarah: 09:34

 But the real breakdown for most practices is consistency in the follow-up.

Brad: 09:38

 And that's where automation really shines. Tools like pay reminders ensure consistency. They automatically send messages at set intervals, say 7, 14 and 21 days after the first bill.

Sarah: 09:49

 And the system is smart enough to stop when once the bill is paid.

Brad: 09:52

 Right instantly, the second the payment registers, the patient is removed from the reminder list. That prevents that classic frustration of paying a bill and then getting a late notice a few days later.

Sarah: 10:03

 Okay, let's talk about the biggest challenge. Those high dollar balances from the HDHPs. This is where flexibility comes in.

Brad: 10:10

 You have to offer options. One solution is something like plan pay, which lets the patient set up their own installment plan. The practice sets the rules the maximum length, the minimum payment, but the patient gets control.

Sarah: 10:22

 And for really high balances, there are.

Brad: 10:24

 Financing options like FlexPay. This is a game changer because the practice gets paid in full, usually the next business day. It completely eliminates the collection risk for them. And for recurring services, there's autopay. The CU idea is simple. Make it easy and flexible for patients to pay and they will.

Sarah: 10:42

 And if an account does go seriously overdue, an integrated collection service can handle the escalation.

Brad: 10:47

 But the practice stays in control. They define the rules for when an account gets sent. The beauty is that the collection service follows up and any payments get deposited directly into the practices account without those huge percentage fees you see with traditional agencies.

Sarah: 11:03

 And the thread tying all of this together is visibility. You move from guessing to knowing that's it.

Brad: 11:10

 These modern systems show you in real time who view their eBill, who ignored the text reminder, who paid. It lets your staff focus their time on the accounts that actually need a human touch.

Sarah: 11:21

 When you put all these connected automated tools together, what our sources call the bill flash wheel of services, the benefits seem pretty immediate.

Brad: 11:28

 They are. Let's just quickly summarize the gains for you, the listener.

Sarah: 11:32

 First, more predictable cash flow. The automated reminders and digital options shrink that gap between providing care and getting paid.

Brad: 11:40

 Second, a huge reduction in staff workload and burnout. Automation handles the hours of tedious, repetitive work.

Sarah: 11:46

 Third, your aging AR goes down. Fewer balances are sitting out there at 60, 90 or 120 days.

Brad: 11:53

 And fourth, a much better patient experience. When the financial side is clear, simple and convenient, patients feel better about the entire practice.

Sarah: 12:03

 So the sources we reviewed all agreed on the same six key warning signs. Let's run through them. Because if you answer yes to two or more of these, your RCM process is probably holding you back financially.

Brad: 12:16

 First, ask yourself, are your account's receivable days steadily increasing?

Sarah: 12:21

 Are patients regularly calling your office with confusion about their bills?

Brad: 12:25

 Does your staff spend hours every single day manually chasing payments and stuff in envelopes?

Sarah: 12:30

 Do you lack any real time visibility into who has viewed, ignored or paid their statements?

Brad: 12:35

 Is your practice management system totally disconnected from your payment or collection services?

Sarah: 12:40

 And finally, are patients asking for flexible payment options like installment plans that you just can't offer easily?

Brad: 12:46

 If you answered yes to two or more of those, the message from our sources is clear. Your RCM is not just inefficient, it's actively hurting your bottom line.

Sarah: 12:55

 The gap between those manual processes and a modern automated system is just wider than you might realize.

Brad: 13:00

 It really is. Modern RCM isn't, you know, a luxury anymore. It's an absolute necessity in a world where patients have more financial skin in the game and expect digital first options.

Sarah: 13:11

 So if automation and flexibility are the keys to RCM success, let's leave you with a final provocative thought. If clear, easy payment options increase your collection rates and reduce staff burnout, what high value patient facing activity could your team accomplish if they got back, say, 10 hours a week that they previously spent just printing, stuffing and chasing bills that reclaim time? That's pure opportunity.

Narrator: 13:34

Thanks for tuning into the Billing Blueprint podcast. For more insights or to dive deeper dive deeper into today's topics. Head over to billflash.com. Don't forget to subscribe and we'll catch you next week with more strategies to keep your practice running smoothly and getting paid faster

Sources:

What Is RCM? Everything Your Practice Needs to Know About Revenue Cycle Management