Protecting Healthcare Margins: The Hidden Risks in Your Revenue Cycle

Healthcare revenue cycles face immense pressure from denials or AR delays and silent inefficiencies that erode margins over time. What you don’t know — or can’t see in your data — is costing you. Revenue cycle health isn’t just about cash flow; it’s about sustainability, compliance, and strategic agility.

For healthcare CFOs, revenue cycle leaders, and operations executives, this guide outlines the most common hidden threats to margin — and actionable steps to uncover and address them.

1. Underutilized Technology

Many healthcare organizations struggle to fully leverage their existing technology systems, including Electronic Health Records (EHRs) and billing platforms. Outdated or poorly integrated systems can lead to inefficiencies, errors, and missed revenue opportunities.

Action Steps:

• Conduct a Technology Audit: Assess current systems for functionality, integration capabilities, and user satisfaction. Learn more about the steps we suggest in improving inefficient systems or processes.
• Bridge the Gaps: Connect clinical and financial platforms to support real-time insights.
• Implement Automation: Utilize tools like Robotic Process Automation (RPA) to streamline repetitive tasks and reduce errors.

Remember: many organizations invest in EHRs and billing systems without optimizing integrations or training. When systems don't talk, processes slow, and revenue stalls.

2. Increasing Accounts Receivable (AR) Days

Rising AR days can indicate deeper issues within the revenue cycle, such as billing errors, claim denials, or inefficient processes. Extended AR periods tie up cash flow and can jeopardize financial health.

Rising AR days are more than a cash flow issue — they’re a sign of process breakdown.

Action Steps:

• Analyze AR Trends: Use data analytics to identify patterns and root causes of delayed payments.
• Enhance Claim Scrubbing: Implement advanced claim editing tools to catch errors before submission.
• Train Staff: Ensure billing and coding teams are up-to-date with the latest payer requirements and coding standards.

3. Inadequate Staff Training

Continuous changes in healthcare regulations and coding guidelines require ongoing staff education. Without proper training, organizations risk compliance issues and revenue loss.

Coding rules and payer policies evolve constantly. A one-time training approach leads to downstream errors.

Action Steps:

• Develop a Training Program: Regularly update staff on changes in billing codes, payer policies, and documentation requirements.
• Monitor Performance: Track key performance indicators (KPIs) to identify additional training areas.

4. Ineffective Reporting

Without accurate and timely reporting, healthcare leaders cannot make informed decisions. Lack of visibility into revenue cycle metrics can mask underlying issues.

Action Steps:

• Implement Real-Time Dashboards: Provide stakeholders with up-to-date financial data to facilitate proactive decision-making.
• Standardize Reporting Metrics: Establish consistent KPIs across departments to ensure alignment and accountability.
• Conduct Regular Reviews: Schedule periodic assessments of financial reports to identify trends and areas for improvement.

5. Making Good Use of Data

Healthcare systems often have more data than they know what to do with. But raw data is only powerful if it’s actionable.

Consider the billing manager manually trying to uncover why AR days are increasing — digging through reports, calling staff, and escalating denials. This process is automated, insightful, and significantly less resource-intensive, with the right analytics.

Analytics can also transform denials management by:

• Categorizing denials by root cause (e.g., missing info, no prior auth).
• Stratifying them by payer and denial type.
• Linking to specific claim-level details for accountability.

Action Steps:

• Prioritize Visibility: Implement dashboards to track aging AR by department, payer, and denial reason.
• Collaborate: Establish a feedback loop between billing, coding, and clinical teams to correct upstream issues.
• Understand Your Data: Invest in data literacy so teams understand and act on insights—not just receive them.

Every department influences the revenue cycle. Denials don’t start at billing — they often start at intake, documentation, or pre-auth workflows.

6. Hidden Revenue Leaks

Beyond visible challenges, hidden revenue leaks—such as under coding, missed charges, and non-compliance—can significantly impact margins. These issues often go unnoticed without thorough audits.

Action Steps:

• Perform Regular Coding Audits: Identify discrepancies and ensure accurate representation of services rendered.
• Enhance Charge Capture Processes: Implement systems to ensure all billable services are documented and billed appropriately.
• Review Payer Contracts: Ensure reimbursement rates and terms are favorable and reflect the services provided.

7. Lack of a Revenue Integrity Program

Revenue cycle breakdowns often stem from disconnects between clinical, coding, and billing teams. When documentation doesn’t match coding or when charge capture is inconsistent, revenue leakage becomes inevitable. That’s where a Revenue Integrity Program plays a key role — aligning people, processes, and technology to ensure all services rendered are accurately captured, coded, and reimbursed.

Without this structure, healthcare organizations risk:

• Incomplete or inaccurate documentation
• Denials due to mismatched clinical and billing records
• Compliance issues and under-reimbursement

Revenue integrity bridges the gap between care delivery and reimbursement. Without it, denials multiply and margin erodes.

Action Steps:

• Assess Your Current Revenue Workflows: Identify areas where clinical documentation, coding, and billing teams operate in silos.
• Establish a Revenue Integrity Function: Create a centralized team or task force to ensure department alignment.
• Leverage Analytics to Monitor Gaps: Use data to proactively spot trends in missing charges, coding variances, and recurring denials tied to documentation issues.
• Create Feedback Loops: Build regular communication between clinicians and coders to promote education and improve documentation practices.

A Revenue Integrity Program doesn’t just prevent denials — it enables your teams to maximize compliant reimbursement by tightening the full revenue cycle from the point of care to claim payment.

Protect your margins and stop silent revenue loss

Protecting healthcare margins requires a proactive and comprehensive approach to revenue cycle management. Many of the greatest threats to financial stability are hidden — buried in AR days, denial codes, poorly used data, or disconnected departments. By building a stronger internal infrastructure with tools like analytics, automation, and revenue integrity programs, you can take control and enhance your financial performance and long-term sustainability.

Eide Bailly’s Revenue Cycle Risk Assessment helps you uncover issues before they impact your bottom line. Whether you’re fixing denial patterns, tightening documentation, or building a revenue integrity function, we’ll help you build a smarter, stronger revenue operation. Learn more.