Articles
Practical thinking for RCM operations
Field notes for leaders evaluating revenue-cycle workflows, operational evidence, and responsible automation.
- Before sending PHI to a claim-follow-up vendor A practical starting checklist for RCM teams reviewing agreements, access, permitted uses, subcontractors, and the end of an engagement.
- The record is part of the outcome Seven questions that help an RCM leader decide whether a claim-follow-up result is ready to use—or still needs another round of work.
- How to run a one-batch claim-follow-up pilot Choose a representative batch, define a usable result, and measure the work your team still has to do before expanding a follow-up engagement.
- Read the remittance, not just the claim A remittance settles one claim and describes a payer. Read across a quarter of them and a per-payer profile appears that nobody had to be told.
- Assemble the history before you start The first minutes on a stalled claim go to rebuilding context that already exists. That work is retrieval, not judgement, and it need not happen then.
- What to write down when you work a claim A note written for the next person is a different note from one written to prove that work happened, and only one of them saves anybody time.
- Paying twice for the same denial The expensive part of working a denial is working out what it means. Most operations pay for that analysis again every time the denial recurs.
- Timely filing is a write-off schedule A filing deadline is the one date on a claim that turns unfinished work into a permanent loss, and it is rarely the date your report shows you.
- The small balances nobody works Small balances are abandoned by a rule nobody wrote down, and the total never appears in any report as a decision someone made.
- What the aging report leaves out An aging report tells you how old a balance is and almost nothing about whether it will pay or what it needs done to it next.
- Queue time and work time Most of a stalled claim's elapsed life is spent waiting to be picked up rather than being worked on. The two halves respond to different things.
- What a clean claim rate hides A clean claim rate grades your intake. It says very little about whether the money arrives, and the two come apart in predictable ways.
- Flat cost, falling odds The cost of working a stalled claim barely moves as it ages. The probability of payment does. That gap is what every triage rule is trading against.
