A recent HFMA study shows that hospital CFOs see revenue cycle – especially medical billing accounts receivable and denials management – as the biggest area of opportunity for AI [1]. This raises a key question: what do revenue cycle leaders need to do to prepare? Considering the complexity of AI technology, choosing a good partner with “pre-AI” revenue cycle expertise is
If you’re a U.S. healthcare provider searching for medical billing and coding services, you’re not alone. Thousands of physician practices, hospitals, and labs nationwide are rethinking how they manage revenue cycle operations – because missed modifiers, lost claims, and endless denials are draining revenue.
Medical billing and coding errors cost U.S. providers billions annually — not just in unpaid claims, but also in compliance risk, staff burnout, and unhappy patients. The good news? With the right blend of technology, process, and expertise, most of these issues are preventable.
Here are 7 proven best practices that top-performing practices, physician groups, and hospitals use to keep cash flow healthy, denials low, and compliance airtight.
Billing and coding are constantly evolving. Every year, CMS, AMA, and commercial payers release updates to CPT, ICD-10, and HCPCS codes. Missing even one update can lead to underpayment or denials — especially in specialties with frequent coding changes like radiology, pathology, and behavioral health.
Best Practice:
Pro Tip: U.S. practices that review coding guidelines regularly see 15-20% fewer denials related to coding errors.
One of the most common reasons for denials? Ineligible patients. Nothing is more frustrating than delivering care and discovering after the fact that coverage lapsed or prior authorization was required.
Best Practice:
Industry Insight: According to MGMA, eligibility issues account for nearly 27% of claim denials [1]. Catching them upfront saves you rework and write-offs.
Clean documentation is the backbone of clean claims. If the diagnosis doesn’t support the CPT, or if signatures and dates are missing, your claim will end up in a denial queue.
Best Practice:
Even a single missed modifier (like 25, 59, or 26/TC) can mean a $500+ revenue loss. Getting it right upfront pays off – literally.
You can’t improve what you don’t measure. Practices that monitor their revenue cycle KPIs consistently outperform those that don’t – and can intervene early when something goes wrong.
Best Practice: Track at least these core metrics:
Use a medical billing dashboard to visualize trends and take action before denials snowball into revenue leakage.
Medical coding audits aren’t just for compliance – they’re for revenue protection. Undercoding costs you money, while overcoding can trigger audits and penalties.
Best Practice:
Our experience shows that proactive audits can recover 3-7% of missed revenue without increasing patient volume.
Manual data entry, claim status chasing, and payment posting are productivity killers. The best U.S. practices are investing in automation and AI-driven RCM platforms to streamline processes.
Best Practice:
Providers using automation report 20–30% faster reimbursement cycles and lower staff workload.
The medical billing and coding landscape changes fast – and a one-time training isn’t enough.
Best Practice:
Implementing these best practices doesn’t just clean up your healthcare revenue cycle, it also improves compliance, reduces staff burnout, and keeps patients happier.
But keeping up with payer changes, coding updates, and endless claim follow-ups can overwhelm even the best in-house teams.
That’s where RevGen-i, 3Gen’s AI-powered revenue cycle management platform, comes in. With RevGen-i, U.S. healthcare providers get:
Together with our expert billing team, RevGen-i helps U.S. providers stay compliant, capture every dollar, and get paid faster, without adding staff or complexity.
Ready to see the difference? Schedule your free RCM assessment and see how much revenue you might be leaving on the table.
[1] MGMA, “6 keys to addressing denials in your medical practice’s revenue cycle,” 18 March 2021. Available: https://www.mgma.com/mgma-stats/6-keys-to-addressing-denials-in-your-medical-practice-s-revenue-cycle.
Running a pathology lab is hard enough without chasing down underpayments, resubmitting claims, or playing phone tag with payers. Yet many U.S. labs are losing thousands each month because of outdated beliefs about pathology billing and coding services.
Let’s bust some of the most common myths we hear from labs and
When it comes to healthcare accounts receivable (AR) and denial management, too many providers are stuck playing whack-a-mole. A denial pops up here, you swing. Another one appears there, you swing again. The problem? By the time one batch of
U.S. healthcare providers know the routine all too well: treat patients, submit claims, and then… wait. Some payments clear, others return with puzzling denial codes, while A/R days pile up like unread emails. But here’s the reality: these “surprises” are rarely surprises at all. The clues are hiding in your data. The real question is – are you looking at it the right way?
Standard healthcare revenue cycle reports are like scorecards after a game: they tell you what happened, but not why you lost or how to play better next time. You’ll see claims submitted, collections posted, and A/R aging. But without context or root cause insight, it’s just a set of numbers with no clear path to improvement.
Advanced RCM analytics, on the other hand, is your playbook. It shows you:
That’s a huge shift in your revenue intelligence engine. It’s moving from “post-game recap” to “sideline coaching.”
Nobody wakes up eager to sift through endless spreadsheets. (If you do, we should talk.) Our brains are wired for visuals, which is why intuitive dashboards are so powerful. The right visualization instantly highlights patterns and outliers – like spotting a denial spike tied to one procedure code or realizing one payer’s turnaround time has doubled.
Interactive dashboards drive accountability. When front-office staff, coders, and A/R teams all see the same truth in real time, collaboration stops being a buzzword and becomes the default.
Here’s where the real transformation begins. Layer AI and natural language processing on top of analytics, and you move from monitoring to predicting and prescribing:
AI-driven analytics means fewer revenue shocks, fewer emergency fire drills, and more time spent actually improving the patient and provider experience.
The key isn’t to boil the ocean. Start small, but smart:
The goal isn’t dashboards for the sake of dashboards. It’s creating insights that make the healthcare revenue cycles shorter, cleaner, and more predictable.
Here’s the kicker: analytics are only as powerful as the access you get to them. Too often, providers partner with RCM vendors who treat reporting like a “deliverable” instead of a window into their own business.
At 3Gen Consulting, we take the opposite approach. Every engagement comes with analytics dashboards baked in – denial patterns, A/R benchmarks, payer scorecards, the works – so you’re never left guessing. It’s not about handing you numbers; it’s about giving you clarity and control.
Because at the end of the day, getting paid in healthcare is complicated enough. Your analytics shouldn’t be. If you’d like to see how 3Gen Consulting brings clarity and transparency to revenue cycle management, we’d love to connect.
