As the infusion and specialty pharmacy market grows, many providers struggle with reimbursement complexities, payer scrutiny and operational inefficiencies. New research from Prochant, in partnership with the in90group, reveals that most pharmacies are unprepared to navigate these challenges, making revenue cycle management (RCM) optimization more critical than ever.

As the home medical equipment (HME) market continues to expand, providers face growing challenges in revenue collection, impacting profit margins. Increased regulation and complexity in navigating payer reimbursement requirements, particularly with Medicare Advantage and commercial payers, are driving reimbursement down, while the challenges of recruiting and retaining skilled billing and collections staff have escalated costs. 

In healthcare revenue cycle management, perfection is impossible. Payers change rules, denials pop up unexpectedly, and fixing one issue often means another is right behind it. The key isn’t eliminating problems—it’s building a steady rhythm of identifying the top issues, tackling them fast, and making small but consistent improvements. By tracking weekly metrics like preventable denials, write-off reasons, billing and cash flow, and KPIs, you can keep your numbers in the best possible range—and keep them there.