Major Healthcare Revenue Cycle Challenges

Complicated payment reforms, reduced reimbursements, and government mandates contribute to delaying and denying payments for Medicare services. Medicare and Medicaid represent a growing segment of the population, and timely and adequate payment from these organizations is classified as a top problem for healthcare professionals.

Claim rejection: There are some technical aspects, such as a missing signature in a medical record, incorrect spelling, or inconsistent data entry. You should continue to monitor your denial tendencies so that patterns can be classified and treated early on from cause versus symptom. You can also get help from healthcare providers at CXC network online via

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Value-based payments: ACA introduced the transition from the fee-for-service model to the value-based payment model. The intent is to improve the quality of healthcare services provided to patients so that healthcare providers are paid based on the value of the care they provide rather than paying for the number of visits or tests requested by patients. This means that healthcare practices must reconcile the new payment model with the traditional fee-for-service environment that changes analytics and metrics to ensure that payments cover costs.

Another factor affecting revenue cycle management is the eighty-five percent of patients who received an advance premium tax credit through ACA rules. They are eligible for a 90-day grace period to pay their outstanding premiums before insurers can cancel their coverage. 

This rule applies to all consumers who purchased subsidized coverage through the Affordable Care Act (ACA) health insurance marketplace. It has the potential to be a problem not only in tracking patients in this situation but also in late payments. Identify if your patient is up to date with their premium payment as part of their registration process.