Revenue Cycle Management
With most healthcare organizations having razor thin margins, a small disruption to your revenue cycle can be catastrophic. We help organizations enhance every aspect of the revenue cycle by improving people (organizational structure and resource allocation), processes, and technologies.
The result is a healthy revenue cycle that supports a strong performing organization and enhances overall patient and provider experience.
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Revenue Cycle Management Services
LBMC is here to support your healthcare practice and healthcare organization’s goal of enhancing financial performance while operating in a compliant environment.
The breadth of our resources allows us to effectively support clients across the entire revenue cycle including
- front (patient access, denial management),
- middle (charge capture, pricing, documentation, coding, revenue integrity, denial management) and
- back (billing, accounts receivable resolution, denial management, vendor management).
Benefits:
- Enhanced Net Revenue
- Increased Efficiency / Reduced Cost
- Enhanced Customer Service
- Reduced Risks
- Improved Employee Satisfaction
Engagement Scope:
- Small Engagements: specific issues or departments
- Large Engagements: revenue cycle transformation, system selection & implementation
Services:
- Performance Improvement
- Revenue Cycle Integration
- Transformation
- Technology Implementation Support
- Resource Support
- Interim Leadership
- Complex Project Management
- Reporting & Benchmarking
- Business Change Enablement
CLIENT SUCCESS:
Evaluating Revenue Cycle Vendor Performance Across a National Health System
One of the largest health systems in the United States relied on two vendors to manage its fully outsourced back-end revenue cycle operations. When hospital leaders raised concerns about billing accuracy, operational efficiency, coding, and compliance, corporate leadership needed an independent assessment of vendor performance—and a clear path forward.
The Challenge
Leadership needed to understand how the two revenue cycle vendors performed across facilities, how they compared with one another, and how their performance measured against national benchmarks.
LBMC’s Approach
LBMC conducted an independent revenue cycle performance assessment across six hospital facilities. Our team worked on-site with hospital and vendor teams to observe workflows, interview leadership, evaluate operational performance, and validate findings across multiple levels of the organization.
LBMC also combined revenue cycle, coding, and compliance expertise to evaluate billing quality, coding practices, monitoring, and auditing processes.
The Outcome
LBMC equipped leadership with:
- Quantitative performance rankings by facility, vendor, and national benchmark
- Financial opportunity analysis identifying improvement potential
- Billing and compliance gap findings with actionable recommendations
- Strategic vendor recommendations, including consolidation and alternative vendor options
The assessment gave leadership an objective, data-driven view of vendor performance and the information needed to make confident decisions about vendor management, performance improvement, and future revenue cycle strategy.
Frequently Asked Questions
How can a healthcare organization improve its revenue cycle performance?
Improving revenue cycle performance requires looking beyond isolated billing or collection issues and evaluating the entire revenue cycle—from patient access and insurance verification through documentation, coding, claims management, denials, billing, and collections.
High-performing organizations use data and operational benchmarks to identify where revenue is being delayed or lost, then address the underlying causes across people, processes, and technology. An independent revenue cycle assessment can help uncover workflow inefficiencies, staffing constraints, technology gaps, and breakdowns between departments that may be affecting financial performance.
For a deeper look at the full revenue cycle and opportunities for optimization, explore our Revenue Cycle Management in Healthcare: 2026 Guide.
Organizations addressing broader operational and financial challenges can also explore LBMC’s Healthcare Consulting Services.
When should a healthcare organization consider revenue cycle consulting?
Healthcare organizations should consider revenue cycle consulting when financial or operational performance begins signaling that the current revenue cycle model is not working as effectively as it should.
Common triggers include increasing claim denials, growing accounts receivable balances, declining cash flow, staffing shortages, poor vendor performance, patient billing complaints, or persistent challenges with coding and documentation. Major organizational changes—including mergers and acquisitions, outsourcing decisions, and EMR or billing system implementations—can also create a need for outside expertise.
Revenue cycle consulting can range from a targeted assessment of a specific problem to an enterprise-wide transformation. The objective should be to identify root causes, quantify improvement opportunities, and establish a practical roadmap for improving performance.
Healthcare leaders evaluating broader improvement opportunities can also explore these strategies for strengthening revenue cycle services.
Why is the healthcare revenue cycle transformation so difficult?
Revenue cycle transformation is difficult because revenue performance depends on interconnected functions, systems, teams, and external payers. A breakdown in one part of the cycle can create financial and operational problems somewhere else.
Healthcare organizations must manage different payer requirements, complex coding and documentation standards, changing reimbursement rules, fragmented technology, interoperability challenges, staffing constraints, and increasing patient financial responsibility. These dependencies make it difficult to improve performance by optimizing one department in isolation.
Successful transformation requires coordination across patient access, clinical documentation, coding, billing, denials, collections, finance, and technology. It also requires clear accountability, reliable performance data, effective change management, and specialized expertise.
As reimbursement pressure and patient demand increase, healthcare organizations should also evaluate how operational efficiency affects financial and organizational performance.
What revenue cycle management metrics should healthcare organizations monitor?
The most important revenue cycle metrics vary by provider type and operating model, but healthcare organizations should monitor measures that reveal how effectively they are capturing revenue, collecting reimbursement, managing denials, and controlling revenue cycle costs.
Key RCM metrics include:
- Collections as a percentage of net revenue to evaluate cash collection performance
- Initial denial rate to identify problems before claims require rework or appeal
- Denial write-offs as a percentage of net revenue to measure the financial impact of denied claims
- Cost to collect to evaluate overall revenue cycle efficiency
- Aged accounts receivable as a percentage of billed A/R to identify balances at greater risk of nonpayment
- Insurance verification rate to measure patient access effectiveness
- Days in discharge not final billed (DNFB) to identify delays between discharge and billing
- Late charges as a percentage of total charges to evaluate revenue capture
- Days revenue in credit balance to evaluate credit balance management
- Bad debt as a percentage of net revenue to monitor patient and payer collection performance
These metrics should not be viewed independently. Monitoring trends together and comparing performance with appropriate benchmarks can help leadership identify where revenue cycle problems originate and where intervention will have the greatest financial impact.
Physician practices can also review LBMC’s four key financial metrics for physician practice success.
How can healthcare organizations reduce claim denials and improve denial management?
Effective denial management begins before a claim is denied. Healthcare organizations should identify the root causes of denials and address recurring problems across registration, insurance verification, authorization, documentation, coding, claim submission, and payer-specific requirements.
A strong denial management program should analyze denial trends by payer, facility, department, provider, denial reason, and financial impact. This allows leadership to distinguish isolated issues from systemic problems and prioritize the changes most likely to prevent future denials.
Technology and automation can also improve denial workflows by reducing repetitive manual work and allowing revenue cycle teams to focus on complex or higher-value accounts.
Organizations with coding-related denial issues can explore LBMC’s Coding & Compliance Services, while payer and reimbursement challenges may require Reimbursement Consulting.
What does a revenue cycle assessment include?
A revenue cycle assessment evaluates how effectively an organization’s people, processes, technology, and external partners support financial performance across the revenue cycle.
Depending on the organization’s needs, the assessment may examine patient access, charge capture, clinical documentation, coding, billing, denials, accounts receivable, collections, staffing, technology, reporting, compliance, and vendor performance.
A comprehensive assessment should go beyond identifying problems. It should benchmark current performance, identify root causes, quantify financial opportunities, and prioritize improvements based on their potential financial and operational impact.
For organizations using outsourced revenue cycle services, an assessment can also evaluate vendor performance against contractual expectations, organizational goals, and relevant industry benchmarks.
How are technology and financial management changing healthcare revenue cycle operations?
Healthcare revenue cycle operations are becoming increasingly dependent on technology, automation, data analytics, and integrated financial reporting. Used effectively, these capabilities can reduce manual work, improve data accuracy, accelerate workflows, and give healthcare leaders greater visibility into financial performance.
Automation can be particularly valuable for repetitive revenue cycle activities such as insurance verification, claim status workflows, denial management, documentation retrieval, payment posting, and reporting. However, technology should support a well-designed process rather than automate an inefficient one.
Healthcare leaders should evaluate technology investments based on measurable financial and operational outcomes, including labor capacity, processing time, cost to collect, denial resolution, cash acceleration, reporting accuracy, and compliance.
These issues are part of a broader shift in healthcare finance. Learn more about four key considerations shaping the future of healthcare financial management.
How does revenue cycle management support healthcare financial performance?
Revenue cycle management directly affects cash flow, reimbursement, operating margins, and an organization’s ability to convert patient services into collected revenue.
Effective patient access, documentation, coding, billing, denial management, and collections can help healthcare organizations improve net revenue, reduce avoidable write-offs, lower the cost to collect, shorten accounts receivable cycles, and create more predictable cash flow.
Revenue cycle performance also depends on accurate financial reporting and an understanding of how reimbursement requirements affect revenue. For example, properly distinguishing contractual allowances from bad debt is important to accurately evaluating financial performance.
For hospitals participating in Medicare, financial performance can also be affected by the accuracy of healthcare cost reports used for reimbursement, benchmarking, and regulatory reporting.
As reimbursement models continue to evolve, health systems and physician groups should also understand how the transition toward value-based reimbursement and contracting can affect financial strategy, reimbursement, and organizational performance.
Revenue cycle management should therefore be viewed as part of a broader healthcare financial strategy rather than as an isolated billing and collections function.
CLIENT SUCCESS:
Automating Insurance Claim Denial Resubmissions
$2M+ in denied claims processed while eliminating 1,000+ hours of manual work annually
Appalachian Regional Healthcare (ARH) worked with LBMC and technology implementation partner EnterBridge to automate a time-consuming insurance claim denial resubmission process. The solution automated the submission of missing documentation for specific denial types, freeing ARH’s patient financial services team to focus on more complex denials and higher-value revenue cycle activities.
After implementation, the automated workflow processed $1 million in denied claims in its first month and $2 million in its second month. Based on ARH’s annual denial volume, the automation also eliminated more than 1,000 hours of manual processing annually, creating additional capacity to address backlogged denials and improve revenue collection.
Results
- $2M+ in denied claims processed in the second month
- 1,000+ hours of manual processing eliminated annually
- Greater staff capacity for complex and backlogged denials
- Improved efficiency across the revenue cycle
Local Expertise, Wherever You Are
With offices in Chattanooga, Memphis, Louisville, Nashville, Knoxville, Philadelphia, and Charlotte, plus remote offices, LBMC partners with businesses across the region and beyond.
LBMC Revenue Cycle Management Team
Let’s Talk About Your Healthcare Organization
Whether you’re navigating regulatory challenges, improving financial performance, or planning for growth, LBMC’s healthcare team is ready to help. We’ll start with a conversation focused on your organization’s goals, current priorities, and where you need support.