Hospitals warned about RCM silos
Consultants are flagging that revenue-cycle management still suffers from siloed workflows that hide operational risk and slow collections, and they recommend connecting systems to improve visibility and throughput. The advisory stresses that reducing handoffs and clarifying ownership across teams yields measurable gains in denials prevention and cash flow. (x.com)
A hospital can treat a patient perfectly and still wait months to get paid if the billing trail breaks between registration, coding, case management, and collections. That is the problem consultants are warning about: revenue cycle work is still split across too many teams and systems to see where money gets stuck. (aha.org, 3genconsulting.com) Revenue cycle management is the chain that starts when a patient is scheduled and ends when the hospital has collected the full payment. The Healthcare Financial Management Association says denials can be created at many points along that chain, which is why one bad handoff upstream can become a cash problem downstream. (hfma.org) The warning is landing at a rough moment for hospitals. The American Hospital Association said in September 2024 that care denials rose 20.2% for commercial claims and 55.7% for Medicare Advantage claims between 2022 and 2023. (aha.org) Those denials are expensive even when hospitals eventually win. The same American Hospital Association report says 75% of Medicare Advantage care denials are later overturned, which means staff often spend weeks reworking claims that should have been paid the first time. (aha.org) A silo is just a wall in the workflow. Registration may hold the insurance data, clinicians hold the documentation, coders translate the chart into billable codes, and the follow-up team sees the denial only after the claim is already broken. (hfma.org, 3genconsulting.com) That is why a missing authorization number or an incorrect insurance field can behave like a tiny typo with a giant price tag. 3Gen’s hospital revenue materials point to front-end eligibility gaps, authorization misses, and inaccurate registration data as denial triggers that back-end teams often cannot fully recover. (3genconsulting.com) Industry groups are pushing the same fix from another angle: common data and shared definitions. The Healthcare Financial Management Association says hospitals need standard denial categories and metrics such as initial denial rate, time from denial to appeal, and time from denial to resolution so every team is measuring the same problem the same way. (hfma.org) Consultants and conference speakers are also converging on integration. A 2025 New Hampshire Information Management Association session on denials success told hospitals to connect coding, clinical documentation integrity, and related functions so data is transparent enough to find root causes instead of just working appeals one by one. (nhima.org) The money involved is not small. The American Hospital Association cites a McKinsey estimate that hospitals and health systems spend about $40 billion a year on billing and collections, while the Healthcare Financial Management Association says administrative complexity across healthcare represents a $265.6 billion savings opportunity. (aha.org, hfma.org) So the advice is less about buying one more dashboard and more about removing blind spots between teams. When ownership is clear and the same claim can be traced from scheduling to payment, hospitals catch denial risks earlier, reduce rework, and turn a slow collections problem back into a process they can actually manage. (3genconsulting.com, hfma.org)
