5 Workflow Bottlenecks That Are Killing Your Revenue—and How to Fix Them

Behind Every Rejected Claim, There’s Lost Revenue
If your hospital, clinic, or physician practice is struggling with revenue performance, outdated workflows are often the culprit. But don’t worry—these bottlenecks are fixable. Let’s walk through the five most common revenue-drainers, and how to address them effectively.

1. Inaccurate Patient Registration Data

Why it hurts:

• Misspelled names, incorrect policy numbers, and outdated coverage information lead to claim denials and rejections—creating costly delays.
• Manual data entry increases errors and back-and-forth communications.

How to fix it:

• Implement real-time eligibility checks and automated insurance verification at registration.
• Sync with payer systems for immediate status updates.

2. Claim Submission Delays

Why it hurts:

• Each day a claim sits unsubmitted is a day of lost cash flow and increased risk of denial due to time limits.
• Manual processes are slow, inconsistent, and error-prone.

How to fix it:

• Use automated workflows that route claims quickly to the right clearinghouses or payers.
• Establish real-time monitoring and alerts for stuck or missing submissions.

3. Insufficient Claim Scrubbing

Why it hurts:

• Errors like incorrect modifiers, missing documentation, or inconsistent coding result in denials and underpayments.
• Manual review often catches issues too late or misses them entirely.

How to fix it:

• Deploy a comprehensive scrubbing engine powered by rules and payer-specific edits.
• Use pre-submission validation to detect and correct errors automatically.

4. Inefficient Denial Management

Why it hurts:

• Denials take time to track, research, and appeal. The longer they linger, the harder they are to resolve.
• Manual tracking leads to lost follow-up and unrecovered revenue.

How to fix it:

• Triage denials with severity scoring and trend analytics.
• Automate appeal letter generation and workflow assignment.

5. Limited Reporting & Analytics Visibility

Why it hurts:

• Without clear data showing where delays and losses occur, it’s nearly impossible to fix broken processes.
• Management and staff lack insight into financial performance, denial trends, or rework backlog.

How to fix it:

• Implement dashboards and KPIs (e.g., clean claim rate, days in A/R, denial volume).
• Set up proactive alerts for key thresholds or shifts in performance.

Take Charge of Your Revenue Pipeline

• Step 1: Evaluate your current workflows—where are registrations, submissions, scrubbing, denials, or analytics falling short?
• Step 2: Prioritize the bottlenecks that are costing you the most.
• Step 3: Leverage automation, validation, and intelligence across each stage.
• Step 4: Monitor performance with live data to ensure sustained and improved ROI.

How OS inc. Can Help

At OS, Inc., we’ve spent more than 30 years helping healthcare organizations overcome the same workflow challenges outlined above. Here's how our customizable solutions align with each of the five critical bottlenecks:

• 1. Inaccurate Patient Registration Data
  Our Consulting and Training services help improve front-end staff accuracy, ensuring cleaner data entry, fewer eligibility issues, and a better patient intake experience from the start.
  
  
• 2. Claim Submission Delays
  Our Third-Party Billing services are designed to streamline claim creation and processing. With experienced billing professionals handling submissions promptly, you can reduce delays and improve cash flow reliability.
  
  
• 3. Insufficient Claim Scrubbing
  OS ensures cleaner claims through Complete AR Billing Support, helping your team maintain compliance with complex payer requirements and avoid common coding errors that lead to denials.
  
  
• 4. Inefficient Denial Management
  Our A/R Reduction Projects and Legacy System A/R Resolution services are built to tackle backlogged or problematic accounts. We identify trends, resolve denials efficiently, and help prevent them in the future.
  
  
• 5. Limited Reporting & Analytics Visibility
  While we don’t offer a software platform, our Consulting Services provide actionable insight into your revenue cycle performance. We help you interpret key metrics like denial rates, A/R days, and cash collections to drive informed decisions.

Whether you're a critical access hospital or a multi-site provider network, OS partners with your team to design a support model that meets your specific needs. We believe your success is our success—and that’s why our services are built around measurable results and long-term improvements.

Ready to take control of your revenue cycle? 
 Connect with OS, Inc. to explore the right solution for your workflow challenges and get back on track—faster. 

References:

• Simbo.ai: Clean Claim Rate & Denial Prevention
• Thoughtful.ai: Best Practices for RCM Automation
• OS, Inc.: Measuring the Cost of Denials
• TechTarget: Back-End Revenue Cycle Best Practices
• MediBill: Internal Medicine Billing KPIs