Gearing Up for End-of-Year Financials in Revenue Cycle Management

As the calendar flips to December, the holiday season brings a mix of excitement and challenges in the world of healthcare revenue cycle management (RCM). Patient volumes tend to spike during this time, as many patients rush to maximize their insurance benefits before deductibles reset—a trend consistently highlighted in MGMA data. However, these higher volumes are often accompanied by staffing shortages caused by holiday PTO and seasonal illnesses, creating a perfect storm of stress and uncertainty for RCM teams. 

To make December a financially strong month and close the 4th quarter with momentum, diligence and focus on key RCM processes are essential. Prioritizing areas like accounts receivable (AR) follow-up, denials management, timely provider documentation, claims turnaround times, and effective front-end processes can help minimize revenue leaks and ensure a smoother year-end close. Here’s how you can stay focused on the right priorities: 

1. Tighten Accounts Receivable (AR) Follow-Up 

Unresolved AR is one of the biggest culprits in year-end revenue loss. December is not the time to let aged claims slide. Assign specific teams or individuals to prioritize high-dollar accounts and older AR buckets. Regularly review AR aging reports and identify claims that need immediate follow-up to secure payment before year-end deadlines. 

Tip: Focus on high dollar claims that are nearing timely filing limits or require payer escalations, as these can be the difference between payment and a write-off. 

2. Ramp Up Denials Management and Prioritization 

Denials tend to surge in December for a myriad of reasons. An effective denials management process begins with categorizing denials to identify patterns and root causes. By understanding the “why” behind denials, you can implement corrective actions in real time. 

Tip: Prioritize actionable denials—those that can still be overturned within the payer’s appeal timeline. Make sure your team is equipped to handle these efficiently and focus on quick resolutions. 

3. Ensure Timely Provider Documentation 

Provider documentation delays can derail claims submissions, creating unnecessary bottlenecks in December’s already compressed timeline. Encourage providers to document promptly, especially for high-dollar procedures and services. Automated reminders or scheduled check-ins can help ensure providers stay on track despite their own busy schedules. 

Tip: Assign a dedicated team member or liaison to manage documentation flow, reducing the risk of delays that push claims into the next year. 

4. Expedite Claims Turnaround Times 

Submitting clean claims quickly is critical to securing revenue before the end of the year. Double-check for common errors like incorrect patient demographics or other mistakes before submission. Leverage clearinghouse tools to spot and correct errors early. 

Tip: Use analytics to monitor claims that are “in-process” or awaiting payer adjudication. Proactively address any potential issues with payers to avoid delays. Most clearinghouses have analytics functions you can turn on to monitor the movement of your claims. 

5. Strengthen Front-End Processes to Prevent Denials 

Prevention is always better than cure. Front-end processes like accurate patient registration, insurance verification, and authorization workflows are your first line of defense against denials. Ensuring these steps are done right the first time can drastically reduce downstream issues. 

Tip: Conduct real-time eligibility checks and confirm patient financial responsibility upfront to avoid surprises later. Use December as an opportunity to audit and refine front-end workflows. 

Prepare for the Holidays, but Stay Focused on the Mission 

While the holiday season brings unique pressures, it’s also an opportunity to set the tone for financial success in the new year. A strong December doesn’t just boost your Q4—it can create momentum that carries into Q1. By staying proactive in AR follow-up, denials management, and front-end processes, you can end the year with confidence and celebrate your team’s hard work and resilience. 

As you gear up for the final stretch of 2024, remember: preparation and focus are the keys to turning December’s challenges into opportunities. With the right strategies, your RCM operations can finish the year strong and ring in 2025 with a well-deserved sense of accomplishment. 

Let’s end the year in celebration!