Effective billing is the backbone of any healthcare provider’s revenue cycle. Yet, providers—whether in home medical equipment (HME), infusion and pharmacy or home health and hospice—often face significant challenges in managing their revenue cycle management (RCM) processes. Inaccurate billing, delayed claims and compliance hurdles not only reduce profitability but can jeopardize a provider’s financial health. Below are some of the top billing challenges healthcare providers encounter, along with how Prochant’s flexible RCM solutions can help resolve them.
Complex and Ever-Changing Regulations
The healthcare industry is heavily regulated and staying compliant with constantly evolving rules from payors like Medicare, Medicaid and private insurers can be overwhelming. Billing errors due to non-compliance lead to claim rejections, denials and delayed payments.
Prochant stays up-to-date with industry regulations and ensures that providers are always in compliance. By leveraging Prochant Pulse, our proprietary technology, workflows are automated to reduce the margin of error. In addition, Prochant’s team of experts constantly monitor and adapt to regulatory changes, helping providers minimize denials and expedite claims approval. This proactive approach not only reduces denials and rejections but also ensures faster reimbursement cycles, while mitigating compliance risks that could lead to costly penalties.
High Denial Rates
Denials are a critical issue for providers, especially when they are left unaddressed or take too long to be corrected. Denials can account for significant revenue losses if not managed effectively, and reworking these claims adds to operational costs.
Prochant focuses on both preventing denials before they happen and resolving them quickly if they do occur. Using AI-driven features like denial prediction and claims scrubbing within Prochant Pulse, Prochant identifies high-risk claims before they are submitted, flagging them for review. When denials do occur, Prochant’s team tracks and resolves them through the appeals process, ensuring that revenue is recovered efficiently. This results in improved cash flow and reduces the time and effort spent on reworking denied claims, allowing providers to focus more on patient care.
Staffing Shortages and Inefficiency
Many healthcare providers struggle with maintaining a skilled and knowledgeable billing staff. Training new hires or upskilling existing employees takes time, and staff turnover can result in costly gaps in RCM processes.
Prochant offers a comprehensive solution for providers facing staffing challenges. With a highly trained team managing the entire billing process—from claim submission to cash posting—Prochant eliminates the need for constant hiring and training. By utilizing AI-powered tools, like smart invoice matching with embedded rules, Prochant optimizes task distribution, improving workforce efficiency and productivity. As a result, providers experience lower overhead costs and enhanced operational efficiency, with the assurance that billing is always handled by experts.
Slow Payment Cycles
Delayed payments are a frequent issue in RCM, as claims often get stuck in processing or encounter back-and-forth denials. This not only hampers cash flow but also increases the administrative burden on providers, who must chase down outstanding payments.
Pulse allows our team to monitor claims in real-time, track submission statuses and even predict payment dates. By automating the follow-up process on outstanding claims and using payment prediction tools, Prochant ensures quicker reimbursement cycles. This helps providers better manage their cash flow and reduces the unpredictability that often affects the payment process.
Lack of Real-Time Data and Analytics
Many providers lack access to real-time insights into their RCM performance, making it difficult to identify bottlenecks, inefficiencies and areas for improvement in the billing process.
Pulse solves this problem by offering real-time analytics, custom reporting and automated workflows that provide deep insights into the billing process. Providers can track where revenue is getting held up, monitor productivity and identify trends in denials, payments and collections. This level of transparency allows for proactive decision-making and continuous optimization of the revenue cycle, giving providers the tools they need to drive ongoing improvement and achieve better financial outcomes.
Billing in healthcare revenue cycle management presents multiple challenges that can disrupt cash flow and drain operational resources. Our blend of AI-driven tools and experienced, global team can help providers overcome these hurdles by ensuring that billing is streamlined, compliant and efficient, ultimately leading to faster payments, reduced denials and improved financial outcomes.
Ready to optimize your billing process? Contact Prochant today to learn how we can help you address your RCM challenges and maximize your revenue.