7 Workflow Best Practices to Elevate Your Revenue Cycle Management

Revenue cycle management (RCM) is only as strong as the workflows behind it. When those workflows are disjointed or manual, they create downstream issues: denials pile up, reimbursements slow down, and staff burnout creeps in.

The good news? With the right strategies in place, healthcare organizations can streamline operations, reduce friction, and boost collections—without burning out their teams.

Here’s a breakdown of the most impactful workflow best practices every healthcare organization should consider.

1.  Map the Entire Revenue Cycle—and Identify the Gaps

Before improving your workflows, you have to understand them. Start by mapping out each phase of the revenue cycle:

• Pre-registration
• Insurance verification
• Charge capture
• Coding
• Billing
• Collections
• Denial management

From there, pinpoint where delays or errors most commonly occur. Is prior authorization slowing down your front end? Are claim edits causing a backlog in billing? Workflow mapping makes it easier to see where automation, training, or system updates are needed most.

2.  Standardize Processes Across Departments

Variation is the enemy of efficiency. Standardizing workflows ensures consistency, especially in multi-location or multi-specialty organizations.

• Use standard templates for patient intake, eligibility checks, and documentation.
• Create playbooks or SOPs that align billing, coding, and clinical teams.
• Eliminate tribal knowledge by documenting key processes in an accessible location.

3.  Leverage Automation Wherever Possible

Manual processes are prone to delays and errors. Consider automating tasks like:

• Eligibility and benefits verification
• Claim status checks
• Charge entry and coding assistance
• Payment posting
• Denial categorization and routing

Automation not only saves time—it also frees up staff to focus on more complex, high-value activities like appeals and patient follow-ups.

4.  Build in Front-End Accuracy Checks

The best way to reduce denials is to get it right from the start. Embed quality checks in your front-end workflows:

• Use real-time eligibility tools at check-in.
• Flag missing or inconsistent demographic data.
• Integrate pre-service authorization verification into scheduling.

Clean data upfront reduces the need for costly rework on the back end.

5.  Improve Interdepartmental Communication

Workflow breakdowns often stem from communication silos. Bridge those gaps with:

• Regular cross-functional RCM meetings
• Shared dashboards or workflow tools (e.g., task management platforms)
• Defined escalation paths for issues between clinical and billing teams

Collaboration ensures that small issues don’t turn into denied claims or patient dissatisfaction.

6.  Use Analytics to Drive Workflow Decisions

Data isn’t just for reporting—it should shape your workflows. Track key metrics like:

• Days in A/R
• Denial rates (by category)
• Clean claim rate
• First pass resolution rate
• Staff productivity benchmarks

Use these insights to fine-tune your staffing, focus training, and optimize workflows based on real-time performance.

7.  Continuously Review and Refine

RCM isn’t a set-it-and-forget-it process. Schedule regular workflow audits to:

• Adapt to changing payer policies
• Identify new bottlenecks
• Incorporate tech upgrades or regulatory changes
• Gather feedback from frontline staff

Lean into a culture of continuous improvement—it’s essential for long-term revenue cycle success.

Efficient workflows are the foundation of a high-performing revenue cycle. When processes are clean, automated, and collaborative, the entire organization benefits—from fewer denials and faster payments to happier patients and less stressed staff.

Want help assessing or optimizing your current revenue cycle workflows? OS Inc. can help. Reach out today to learn how our RCM experts can support your financial goals.

References

• HFMA. "Revenue Cycle Management Best Practices"
• MGMA. "Key Metrics for Medical Practice Revenue Cycle"
• AHA. "Improving Financial Performance through Operational Efficiency"