Menu Close



Whether you want more information about what you’ve seen or are ready to schedule a demo with one of our experts reach out today!

Red Flags in the Healthcare Revenue Cycle

a person enters numbers after recognizing red flags in the healthcare revenue cycle

Healthcare revenue cycle issues plague just about every behavioral health and substance use disorder treatment provider. It’s important for your organization to see and react to the red flags in the healthcare revenue cycle because every issue faced will put up a roadblock on the path to profitability. The best behavioral health revenue cycle management (RCM) software will help you and your staff seamlessly handle everything from the ability to collect payments in a timely manner to serving patients efficiently in a value-based care model to drive revenue for your organization. Contact Sunwave Health online or by calling us at 561.576.6037 to learn how our purpose-built software can help drive healthy results for your business and your patients.

The Impact of Healthcare Revenue Cycle Issues

Healthcare revenue cycle issues are present at every stage of the patient journey, starting with patient access and continuing through claims, billing, payment, and collection process. Thankfully, smart, modern software tools also exist and can help mental health and substance abuse treatment providers just you read and react to the most common healthcare revenue cycle issues.
The impact of not spotting the red flags in the healthcare revenue cycle can lead to your organization losing revenue if not addressed swiftly. With automation, data collection, analytics, and other digital tools, Sunwave Health’s RCM can help your staff manage the complete patient journey and adapt to their evolving needs.

Red Flags in the Healthcare Revenue Cycle

One of the major financial challenges in healthcare is adequately managing the revenue cycle to sustain the organization and make a profit at the same time. Behavioral health and caring for patients with substance use disorders come with specific nuances, more complex financials, and administrative concerns that other healthcare providers do not have to face. Therefore, the RCM processes can be a bit more complicated, with more healthcare revenue cycle issues to overcome, such as these red flags in the healthcare revenue cycle.

Patient Access Issues

Most individuals today use mobile apps and online access to do just about everything, from shopping for groceries to transferring money between bank accounts, quickly and with virtually no pain points along the way. When they’re choosing a healthcare provider for loved ones in need of mental health or addiction treatment, they will demand an equally seamless experience for scheduling appointments and insurance verification. Having full mobile access for your patients to use to provide your staff with information and view their own data is essential. Sunwave Health’s infrastructure provides a patient portal as well as automated tools to better help you engage with your patients.

When paired with accurate treatment cost estimates and convenient payment options, more patients will want to be cared for by your organization, and that can all but eliminate this reg flag in the healthcare revenue cycle.

Appropriate Revenue Capture

Organizations offering specialized care are more vulnerable to inadequate charge entry processes than standard healthcare providers, and appropriate revenue capture is crucial to your revenue cycle. If the correct dollar value is not entered, you may not be adequately reimbursed for the treatment, care, and services your staff provided. In specialty care, this process is a challenge because the conditions being treated may be more complex, and therefore the fee schedules are not always straightforward. Additional face-time with patients during an appointment is often needed, and multiple systems may be used to gather information on bundled payments or value-based care protocols. Your business needs to be able to capture revenue correctly throughout the entire patient journey.

Changes to Healthcare Regulatory and Compliance Standards

Two things are standard in healthcare: there will be patients needing treatment, and regulatory and compliance standards will always be changing. New regulations are a constant, and this is one of the biggest healthcare revenue cycle issues that providers like you need to keep up with. Not being on top of the new regulations and compliance standards can lead to the denial of claims, delays in patient and insurance payments, administrative backlogs, and billing issues.

Lack of Data-Driven Analytics

Software that provides for efficient revenue cycle management will be data-driven and use analytics to provide a big-picture look at everything happening throughout your organization. Busy healthcare providers are too often in the weeds fixing individual claims, but if you want to improve your revenue cycle, you must have a partner to help identify trends and find the biggest opportunities to improve your results. Having access to data and analytics is essential for your organization to spot and address any potential problem areas in:

  • Claims
  • Billing
  • Payment

When your revenue cycle management system collects, analyzes, and harnesses the correct data, your team can optimize:

  • Patient access
  • Billing efficiency
  • Reimbursement
  • Payer performance

Learn More at Sunwave Health

Do these red flags in the healthcare revenue cycle sound familiar? Are you experiencing too many healthcare revenue cycle issues within your organization? Contact Sunwave Health today by calling us 561.576.6037 or reaching out online to learn how our infrastructure and software set us apart to drive healthy results for healthcare providers and patients.