Nowadays,, revenue loss in healthcare is a growing crisis. Even some of the top U.S. hospitals, with all their resources, have struggled to keep up with rising operational costs, losing millions along the way. Rural Health Clinics (RHCs), which often operate with tighter budgets and fewer safety nets, every dollar counts.
Studies show that revenue leakage can account for up to 20% of lost income, and a major share of unpaid claims, i.e., nearly 75%, come down to unanswered billing questions or errors.
Across the industry, providers of all sizes from large hospitals to small-town clinics are facing mounting financial pressure. In rural areas, where nearly 40% of hospitals are operating in the red, a single billing misstep can threaten long-term sustainability. This is why revenue cycle billing is a vital part of your clinic’s financial survival
Are you making the most of your RHC billing potential? Or are outdated processes, coding mistakes, and denial backlogs holding your clinic back from earning 20% more revenue or even more?
In this blog, we break down the key reasons RHCs are missing out and what you need to look out for.
What is Holding your RHC Back from Higher Revenue?
Even though RHCs get better payment rates, many are not making full use of this benefit. These clinics can increase their revenue by 25% to 75%, but most of them are missing this chance due to the following factors:
- Inefficient Revenue Cycle Management (RCM):
RHCs often have gaps or delays in their billing process, starting from patient registration to final payment. Missing steps or incorrect information during this cycle causes claim issues and delayed reimbursements. These inefficiencies result in underpayment or non-payment, directly lowering the clinic’s total revenue potential.
RHCs should use a strong RCM system to manage billing from start to finish. It should cover patient registration, insurance checks, correct coding, and payment collection. A complete and smooth process helps avoid errors, reduces claim denials, and ensures RHCs receive the full payments they deserve.
- Coding Errors:
Frequently, using incorrect or outdated medical codes is an obstacle in Rural Health Clinics (RHCs) billing. If the billing staff enter the wrong codes, the claims may be denied or paid at a lower rate. Simultaneously, numerous repeated coding errors lead to greater work for administrators and a lower amount of revenue RHCs are able to receive.
To avoid such loss, RHCs need to use specific codes to get paid properly by Medicare and Medicaid. Clinics should train their in-house team regularly and do coding audits to find mistakes. With proper and up-to-date coding, RHCs can avoid denials and make sure they are paid the correct amount every time.
- Inaccurate Charge Capture:
RHCs sometimes fail to record every service provided to a patient. Missing charges mean those services never make it to the billing system. If clinical documentation is incomplete or not properly shared with billing staff, the clinic ends up losing money it should have rightfully collected.
As a result, every service an RHC provides should be recorded and billed. Clinics can use tools that link with patient records to catch every charge. In-house teams should also be trained to double-check their entries. Good charge capture helps RHCs avoid missing services and ensures they bill for everything they do.
- Claim Denials:
Denied claims are one of the core causes of lost revenue for RHCs. Denials typically occur due to lack of the documentations, incorrect patient information, or patient eligibility issues. If denied claims are not followed up in a timely manner, they become unpaid and cause significant loss of revenue in the long run.
To address the claim denials, RHCs must identify the core causes and try their best to fix those problems at the earliest. It is important to track denials, correct errors, and resubmit claims quickly. In addition, having a process to review and address denials keeps clinics from losing revenue and future billing problems.
- Lack of Awareness:
Some RHCs don’t fully understand how their special reimbursement model works. They may unknowingly follow general billing rules instead of RHC-specific ones. This lack of knowledge leads them to miss out on higher payments under the RHC payment system, constraining their revenue expansion.
It is important for RHCs to remember that Medicare and Medicaid rules often change. Thereby, RHCs should stay updated on new billing guidelines and attend training sessions when possible. Being aware of the latest rules helps them follow correct procedures and take advantage of billing opportunities that can boost clinic revenue.
- Outdated Billing Practices and Systems:
Many RHCs still use old billing software or manual processes not designed for RHC billing rules. These outdated systems increase the chances of billing mistakes, slow down claims, and create barriers to accurate reporting. As a result, RHCs miss opportunities to maximize their earnings.
RHCs should switch to updated billing systems made for their needs. Modern software helps with coding, charge capture, and claim tracking. It also reduces errors and saves time. With better tools, RHCs can speed up payments, improve accuracy, and earn more from the services they provide.
Is it Time to Outsource RHC Billing?
Are you facing frequent billing delays, low collection rates, or long AR days? If yes, then it is the right time to consider outsourcing to 24/7 Medical Billing Services.
Expert billing teams make sure claims are submitted correctly the first time, which reduces rejections and shortens the Accounts Receivable (AR) cycle. When denials happen, they are handled quickly and professionally, with proper follow-up or appeal to recover the revenue. Therefore, working with 24/7 Medical Billing Services ensures both immediate recovery of lost revenue and long-term improvement in your RHC billing system.
FAQs
Q1. What does CO-97 denial mean?
CO-97 denial refers to a situation when the service is bundled with another and not payable separately.
Q2. What is AR calling in RHC billing?
AR calling involves following up with insurers on unpaid claims to resolve issues and ensure timely healthcare reimbursement.
Q3. How is RHC billing different from regular medical billing?
RHC billing uses an all-inclusive rate (AIR) model for Medicare and often involves separate billing processes for non-RHC services.
Q4. What services are included under RHC all-inclusive rate (AIR)?
AIR includes medically necessary primary care and qualifying mental health services provided by core providers.
Q5. What is the average revenue increase after RHC billing optimization?
RHCs often see a revenue boost of 33% to 50% with efficient billing practices and proper reimbursement capture.
Q6. What software is used for RHC billing?
RHCs use specialized EHR and billing software tailored to support AIR billing, UB-04 forms, and Medicare compliance.
Q7. What forms are used in RHC billing?
RHCs primarily use the UB-04 form for Medicare billing and CMS-1500 for non-RHC services.
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