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Top 4 healthcare RCM challenges for 2025 and how to overcome them

Revenue cycle management (RCM) challenges are constant in the healthcare industry, and 2025 will be no exception. This year presents a unique set of difficulties. Overcoming these obstacles is crucial for maintaining operational effectiveness, preserving financial stability, and improving the patient experience.  

At Health Prime, our billing experts compiled a list of the top four RCM challenges healthcare businesses face in 2025 and some strategies for addressing some strategies to address them effectively.    

1. Labor shortage in healthcare billing    

Labor shortages are not exclusive to 2025; however, they seem likely to continue this year. As experienced professionals retire and fewer individuals enter the field, healthcare businesses struggle to find skilled billing and coding staff.     

According to the American Hospital Association (AHA), there will be a critical shortage of 3.2 million healthcare workers by 2026. This shortage can lead to increased errors, slower claims processing, and delayed reimbursements.    

The critical staffing shortage of healthcare workers has forced hospitals to increase costs, which we’ll address as the next RCM challenge for businesses.   

To address this challenge, businesses can invest in automation tools and technology-driven solutions, such as AI-assisted coding and claim scrubbing, to improve accuracy while reducing your teams’ workload.  

Delegating your healthcare billing tasks to an RCM expert can help:  

  • Alleviate the administrative burden  
  • Enhance operational efficiency  
  • Reduce the costs of billing in-house    

2. Rising costs and decreasing reimbursements  

Healthcare organizations face the challenge of rising operational costs while juggling increasing operational costs. This financial pressure is compounded by changes in payer policies, increased administrative expenses, and the need for advanced technology to stay competitive.    

Medical Economics expressed that high expenses continue to exacerbate financial pressures, stating that:  

  • Total expenses have increased across labor and non-labor metrics year-over-year (YOY) 
  • Purchased services experienced the most significant YOY increase at 8.2% 
  • Non-labor costs rose by 5%, contributing to a 4.7% overall increase in total expenses 
  • Labor costs increased by 5.4% between November 2023 and November 2024 

On the other hand, gross revenues declined month-over-month, with this data from October to November 2024:   

  • Outpatient revenue dropped by 10.1%  
  • Inpatient revenue decreased by 6.0%  
  • Gross operating revenue fell by 8.6%  

Therefore, healthcare administrators should regularly analyze their revenue cycle to identify potential RCM challenges and inefficiencies and implement proactive measures. Negotiating better payer contracts and leveraging data analytics can uncover opportunities to maximize reimbursements and minimize expenses.    

3. Enhancing the patient’s financial experience    

Patients shoulder a significant portion of healthcare costs. Therefore, the patient’s financial experience is critical. Some aspects that can lead to dissatisfaction and delays in collections are:   

  • Confusing billing statements  
  • Lack of price transparency  
  • Insufficient payment options  

Healthcare businesses’ financial focus must shift from cost containment to maximizing cash flow into the system today, ensuring more visits from loyal patients and enhancing the financial experience.     

The Healthcare Financial Management Association (HFMA) states that health systems should design payment strategies to improve collections and enhance the financial experience with the patient at the center.    

By simplifying the payment process and making it more patient-friendly, hospitals and health systems can significantly boost operating margins and shorten long accounts receivable cycles.  

Implementing a patient-centric approach to billing is essential. This includes offering clear, detailed statements, providing upfront cost estimates, and enabling flexible payment plans.   

Also, digital payment platforms that allow patients to pay bills online or through mobile apps can enhance convenience and satisfaction. Learn more about this in our whitepaper How to Improve your Patient Collections Process.   

The healthcare sector is always changing, and payer requirements and rules are regularly updated. Staying current with regulations is a complex and continuous process that includes completing reporting requirements, integrating with value-based care programs, and implementing updated coding standards, such as ICD updates.  

Healthcare organizations must continue to take the initiative to navigate these obstacles. Maintaining seamless financial operations and building trust with payers, patients, and regulatory agencies are compliance goals beyond avoiding fines. However, organizations dealing with a lack of resources, a high patient volume, or antiquated procedures may find it especially difficult to accomplish this.   

Providers must have a strong compliance plan and access to professional assistance to adjust to regulatory changes successfully. Frequent staff training lowers errors and increases claim accuracy by ensuring teams remain current on the most recent coding standards and payer requirements. Relying on an RCM partner offers efficient solutions for intricate requirements and industry experience.  

Regular audits can also assist you in locating and proactively addressing compliance gaps. By taking these steps, healthcare businesses can continue to operate efficiently, lower financial risks, and comply with changing requirements.   

Overcome your 2025 RCM challenges with Health Prime! 

Navigating RCM challenges in your business might seem daunting. However, counting on a reliable, experienced, and innovative partner can help you relieve the burden.   

Health Prime provides comprehensive RCM solutions tailored to your business’s specific needs. We work as an extension of your business, combining experienced billing professionals with cutting-edge automation tools to ensure seamless operations even during labor shortages. We also leverage advanced analytics and proven strategies to reduce costs, optimize reimbursements, and improve financial performance.    

Our patient-centric billing solutions emphasize improving customers’ financial experiences. Furthermore, our regulatory compliance support guarantees efficiency and compliance by keeping your practice ahead of changing rules.   

Partner with Health Prime to overcome the top RCM challenges of 2025 and set your practice up for long-term success. Reach out to us at [email protected]. Our team will set up a meeting to discuss how Health Prime can maximize your revenue by cutting costs, saving you time, and collecting more!        

Subscribe to our Health Prime blog. Stay tuned to all the latest updates, learn how to improve your medical practice, and ensure you are getting paid for your work.

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