5 Best Practices to Clean Up RCM AR and Strengthen Your Revenue Cycle

Here are five proven best practices to help clean up your RCM AR, reduce denials, and drive financial performance.

How to improve:

• Build workflows that trigger PA requests as soon as a procedure is scheduled.
• Leverage technology to track authorizations and send reminders before expiration.
• Educate staff on payer-specific requirements to reduce avoidable errors.

Getting ahead of prior authorizations helps prevent downstream bottlenecks and ensures patients receive care without unnecessary interruptions.

2. Verify Insurance Before Scheduling Appointments

Insurance eligibility errors are a common source of denied claims and unexpected out-of-pocket costs for patients. Verifying coverage before scheduling reduces these risks and allows staff to address any issues early.

How to improve:

• Check patient coverage at the time of appointment request, not on the day of service.
• Confirm benefits, co-pays, and pre-authorization requirements with payers.
• Train front-desk teams to communicate coverage details and potential patient costs clearly.

This upfront step creates a smoother experience for patients and protects your organization from revenue loss.

3. Strengthen Clinical Documentation for Accurate Coding

Incomplete or unclear documentation can result in coding errors, underpayments, or claim denials. By focusing on Clinical Documentation Improvement (CDI), providers can ensure coding reflects the complexity of care delivered.

How to improve:

• Engage CDI specialists to review charts for completeness and accuracy.
• Provide ongoing training to physicians on the importance of specific, detailed charting.
• Implement real-time alerts in your EHR to flag missing or ambiguous information.

A strong CDI program not only supports compliance but also captures appropriate reimbursement for services rendered.

4. Utilize IDR for Out-of-Network Claims Under the No Surprises Act

Out-of-network claims often lead to delayed payments or disputes between providers and payers. The No Surprises Act introduced the Independent Dispute Resolution (IDR) process to help settle these cases fairly.

How to improve:

• Identify out-of-network scenarios early and communicate coverage details to patients.
• Assemble documentation—including charge data and provider credentials—to support IDR submissions.
• Monitor deadlines closely to avoid missed opportunities for reimbursement.

Using IDR effectively can help recover lost revenue and protect your organization from uncompensated care.

5. Conduct Pre-Bill Reviews to Catch Errors Before Submission

Even small mistakes on a claim can lead to costly denials or delays. A pre-bill review process allows physicians to review documentation and coding before claims are submitted.

How to improve:

• Establish a workflow for physician review of key billing elements such as diagnosis codes, modifiers, and medical necessity.
• Use checklists to ensure all required information is present and accurate.
• Provide regular feedback on common errors to drive continuous improvement.

This step adds a layer of quality control that can dramatically increase first-pass claim acceptance rates.

Ready to Clean Up Your AR?

At NYX Health, we specialize in helping healthcare organizations simplify their revenue cycle processes and improve financial outcomes. From prior authorization support and insurance verification to CDI programs and IDR assistance, our team can help you reduce denials and maximize reimbursements.

Learn more about NYX Health’s RCM solutions