Why Medical Billing and RCM Have Become One of the Hardest Parts of Running a Healthcare Practice
- revenuequestllc
- Jan 5
- 8 min read
Updated: Jan 5
Published: January 5, 2026
Last Updated: January 5, 2026
Author: Marketta Burrell, CRCP
Company: RevQuest LLC
Important Disclaimer: This content is provided for educational and informational purposes only and does not constitute legal, medical, or professional advice. Healthcare compliance requirements can vary by state, payer, and type of practice. Readers should consult with qualified healthcare attorneys, compliance professionals, and their professional advisors before implementing any compliance strategies discussed in this article. RevQuest LLC does not provide legal advice and recommends working with qualified legal counsel for specific compliance guidance.
Providing care has always been demanding.
Getting paid for that care should not be.
Yet for many healthcare practices heading into 2026, revenue feels harder to secure than it did just a few years ago. Not because the care is wrong. Not because the team is careless.
But because the system around payment has become more complex, less forgiving, and harder to manage with limited internal resources.
If it feels like your practice is doing everything right and still struggling to keep cash flow predictable, you are not imagining it.
A Real-Life Example: “I didn’t know where to start.”
I have sat with practice owners who didn’t come into that conversation angry or careless. They came in tired.
One said, “I knew the A/R was high. I just didn’t know where to start.”
When we pulled the aging, the issue wasn’t that claims were being denied left and right. It was quieter than that. Claims in the 70–90 day range had no documented follow-up. They were not worked on, not touched, just sitting.
The owner didn’t need a lecture. They needed a clear starting point.
Once we separated what was still recoverable from what was already past key windows, the stress shifted. Not because the workload disappeared, but because the next step finally became obvious.
Before you fix anything, you need to know what’s still recoverable, what’s at risk, and what’s already lost.
That’s the A/R Recovery Scorecard’s job.
Not a cleanup.
Not outsourcing.
Not services.
Clarity first.
What I’m Seeing Going Into 2026
Over the past several weeks, I’ve reviewed A/R aging reports across multiple healthcare practices.
The pattern is consistent:
Claims sitting in the 70–90 day range with no documented follow-up.
Q4 denials are still unresolved as January begins.
Teams are working hard, but without clear visibility into what’s actually recoverable.
These are not isolated breakdowns. They are structural gaps that don’t surface until weeks later, when cash flow tightens and options narrow.
Why does medical billing and RCM pressure feel constant for healthcare practices now
Most practices are not dealing with one big billing failure. They are dealing with many small issues that compound quietly.
Common patterns practice leaders describe:
Claims are submitted, but payments arrive late or not at all.
Denials increase, even when processes have not changed.
A/R grows slowly, without a clear explanation.
Staff spend more time reacting than resolving.
Decisions about hiring, equipment, or growth get delayed due to uncertainty.
The pressure is not loud; it is persistent.
And it is happening across specialties.
Across healthcare, medical billing and RCM have become harder to manage internally as payer rules change faster and follow-up windows narrow.
Industry trends confirm what practices are experiencing day to day: denial rates are rising, payer requirements are changing faster, and a growing percentage of denied claims are never reworked.
Once claims age beyond certain windows, recovery options narrow or disappear entirely.
The result is revenue that does not vanish all at once.
It expires.
The revenue leaks that most practices do not see right away
Small intake mistakes carry outsized consequences.
Incorrect insurance information
Missed coordination of benefits
Eligibility is not reverified when plans change
These issues rarely look serious at check-in. Weeks later, they show up as denials, rework, or patient balances that are difficult to collect. Each correction takes time, and time is the one resource most practices no longer have.
A practice once brought me in because they felt like they were “doing everything right,” but payments were still inconsistent.
The root cause was not a complicated coding issue. It was a simple intake problem that kept repeating: insurance was being captured most of the time correctly, but the coordination of benefits wasn’t being confirmed when patients changed plans.
The result was predictable: claims went out, and denials came back weeks later. Staff had to rework them while juggling phones, patients, and everything else. Some got fixed. Others aged out quietly.
That's what most practices don't see in real time. A small front-end miss becomes a back-end revenue leak that costs time, cash flow, and morale.
Lesson learned: Clean claims are built before the claim is ever created.
Prior authorization gaps that stall both care and payment
Authorization requirements are no longer limited to high-cost procedures. They now touch imaging, therapies, medications, and follow-up care across many specialties.
When approvals are delayed, expired, or insufficiently documented:
Claims are denied after services are rendered
Appeals consume staff bandwidth
Revenue stalls while clinical schedules stay full
This creates a disconnect between the work being done and the payment arriving.
Lesson learned: Authorization management is now a revenue function, not a clerical task.
A/R follow-up that falls behind without warning
Few practices intentionally ignore follow-up. Most simply cannot keep up with the pace.
When teams are short-staffed or overwhelmed:
Rejected claims sit uncorrected
Appeals miss filing deadlines
Older balances remain untouched
What starts as a temporary delay quietly turns into a permanent loss.
I've seen practices get dangerously close to losing revenue they already earned—simply because no one realized the clock was running out.
In one review, we found a group of claims sitting untouched, weeks away from hitting filing deadlines. Not denied. Not rejected. Just unworked.
The problem wasn’t that the team didn’t care. They were buried. Follow-up kept getting pushed to “tomorrow,” and tomorrow kept moving.
That’s why A/R doesn’t usually fail loudly. It fails in the quiet windows, when claims still look recoverable—until they aren’t.
Lesson learned: Speed matters more than perfection in revenue recovery.
Why compliance changes in 2026 raise the stakes
Payment challenges are not easing. They are intensifying.
As practices head into 2026, they are navigating:
One of the largest CPT update cycles in recent years.
Continued evolution of E/M documentation standards.
Medicare fee schedule adjustments that compress margins.
Expanded telehealth policies that introduce new coding rules.
Ongoing privacy and compliance deadlines with real financial consequences.
Each change adds cognitive load. Each update increases the margin for error.
Most practices do not lack intelligence or commitment. They lack the capacity to continuously absorb change while maintaining day-to-day operations.
Lesson learned: Experience and pattern recognition matter more than memorizing rules.
Why are more practices rethinking in-house billing
Against this backdrop, many providers are reassessing whether the traditional in-house billing model still makes sense.
Across healthcare, a clear trend has emerged: a majority of practices now plan to outsource some or all revenue cycle functions within the next two years. This shift is not about convenience. It is about sustainability.
What is driving the move toward outsourcing
Workforce shortages make experienced billing staff difficult to recruit and retain.
Rising costs are tied to salaries, benefits, and ongoing education.
Regulatory complexity that outpaces internal training cycles.
Revenue risk caused by delayed follow-up and missed windows.
For many practices, outsourcing is no longer a last resort. It is a strategic response to a changed environment.
Lesson learned: The model changed. The expectations did not.
What healthcare practices are expected from an RCM partner now
Outsourcing expectations have evolved.
Practices are no longer willing to hand revenue to a black box. They want:
Clear visibility into what is happening with their claims.
Regular, understandable reporting.
Accountability for follow-up and outcomes.
Communication that feels like an extension of their team.
Outsourcing only works when transparency improves, not disappears.
This perspective comes from years of working inside revenue cycles across healthcare practices, seeing where revenue breaks down long before it ever shows up on an aging report.
What changes when RevQuest LLC becomes the added team member
The goal is not to replace your staff.
The goal is to add experienced revenue expertise without adding in-house cost or risk.
When revenue cycle work is handled by a dedicated partner:
Issues are identified earlier.
Follow-up becomes consistent instead of episodic.
Decision-makers gain visibility into what is recoverable now versus what must be prevented going forward.
Staff regain time to focus on patients and operations.
Revenue becomes something you can manage intentionally, not guess at.
Now support versus later support
Practices often need help in two different ways.
Support you may need now
A/R visibility and triage
Identification of at-risk revenue
Stabilization of follow-up and workflows
Support you may need going forward
Ongoing denial pattern monitoring
Compliance and payer rule awareness
Prevention of repeat revenue loss
Recovery and prevention are different workstreams. Both matter.
Getting clarity before deciding what to fix or outsource
At RevQuest LLC, this is where the A/R Recovery Scorecard comes in.
It is not a billing audit, and it is not a sales call.
It is a structured way to understand what is actually happening inside your accounts receivable, so decisions are based on facts, not assumptions.
The Scorecard helps practices identify what can still be recovered now, what needs immediate attention, and what must be prevented to stop further revenue from expiring.
That’s it.
No feature list.
No pricing.
No pitch.
If you are deciding whether outsourcing makes sense
The right question is not, “Can we keep billing in-house?”
The better question is, “Do we have the capacity to manage this level of complexity without sacrificing visibility, staff, or growth?”
If getting paid has become one of the hardest parts of running your practice, that is not a failure. It is a signal.
Who This Is For
If you’re a practice owner, administrator, or operations leader, this decision usually shows up quietly.
Not as a crisis — but as uncertainty.
You know revenue feels tighter. You see A/R growing.
But you don’t yet have a clear picture of what’s recoverable, what’s at risk, and what’s already lost.
The A/R Recovery Scorecard exists to answer those questions objectively before you decide whether to fix internally, outsource, or escalate.
It’s not about doing more work.
It’s about knowing where to focus.
If you are unsure what is still recoverable, what is already at risk, or what issues need to be prevented next, the A/R Recovery Scorecard is the right place to start.
It provides a clear view of what is actually happening inside your accounts receivable so you can make informed decisions before committing to cleanup, outsourcing, or ongoing support.
With the right structure and support, patient care and predictable revenue do not have to compete.
They can coexist.
RevQuest LLC supports healthcare practices across specialties with revenue cycle clarity, accountability, and experienced oversight. Whether you need immediate visibility or long-term stability, the right next step starts with understanding what is actually happening inside your revenue cycle.
Marketta Burrell, CRCP, is the founder and CEO of RevQuest LLC™ and creator of Revenue Reset™, Downcoding Defense™, and the Denial Decoder™.
With over 23 years of healthcare revenue cycle experience, she helps providers navigate payer policy changes, identify hidden underpayments, and strengthen revenue integrity across their practice.
You don’t have to face payer pressure alone.
RevQuest LLC™ and Revenue Reset™ are here to support you — from strategy to systems to survival.
📚 Sources & Further Reading
AMA (American Medical Association). CPT® 2026 Code Set Overview.
https://www.ama-assn.org/practice-management/cpt/cpt-2026-code-set
AHIMA Journal. Claims Denials: A Step-by-Step Approach to Resolution.
https://journal.ahima.org/page/claims-denials-a-step-by-step-approach-to-resolution
Experian Health.Denials Management: How to Reduce Claim Denials.
https://www.experian.com/healthcare/solutions/claims-and-denials-management
TechTarget. Healthcare organizations turn to RCM outsourcing amid staffing shortages.
https://www.techtarget.com/searchhealthit/feature/Healthcare-organizations-turn-to-RCM-outsourcing
CMS (Medicare Telehealth & PFS Updates). Medicare Physician Fee Schedule Overview.
RevQuest LLC Blogs - www.revquestrcm.com/blogs
Navigating Revenue Challenges in Healthcare: Beyond Just Billing
https://www.revquestrcm.com/post/just-bill-it-doesnt-work-anymore-ar-in-healthcare
The Silent Downcoding Trend: Why It’s No Longer Just Cigna
https://www.revquestrcm.com/post/the-silent-downcoding-trend-why-it-s-no-longer-just-cigna
Unlock Your Profit Potential: Why RevQuest LLC's Revenue Recovery Path is Essential for Your Practice Today
Stop Losing Revenue: Why A/R Recovery Audits Matter for Healthcare Practices.
https://www.revquestrcm.com/post/a-r-recovery-audits-for-healthcare-practices
Disclaimer: This content is for educational and strategic analysis purposes only and does not constitute legal, financial, medical, or business advice. Healthcare practices should consult with qualified legal, financial, and business advisors familiar with their specific circumstances, contracts, and local market conditions before making any strategic decisions regarding payer contracts or business operations.
I know billing has changed, but it’s still hard to tell what’s impacting us the most right now. Between denials, slower payments, and staffing gaps, it’s not always clear where to focus first.
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This resonates. The biggest challenge for our team isn’t just billing the claim. It’s keeping up with payer changes while staying on top of follow-ups. It often feels like we’re reworking the same issues instead of fully resolving them.