The current healthcare environment is extremely unpredictable, and revenue cycle managers (RCMs) at hospitals are facing more pressure and complexity than ever before.
From technology transformation and AI adoption to economic headwinds and payer hurdles, the role has evolved from back-office operations to strategic frontline leadership.
Here’s a breakdown of the some of the biggest challenges facing RCMs today, and why solving them is mission-critical for hospitals’ financial survival.
Technology Is a Double-Edged Sword
Healthcare tech is advancing fast, but not always in sync. RCMs are dealing with fragmented systems, clunky integrations, and outdated platforms that slow down workflows and hurt revenue capture.
The challenge? Implementing new tools without disrupting operations or draining budgets. Also, training existing staff on how to use these new tools and/or hiring new talent with experience in tech.
AI: Promise vs. Practicality
AI is everywhere… from coding assistants to denials prediction. But hype aside, real-world implementation is slow, expensive, and complicated.
RCMs are being asked to lead AI adoption, but success depends on data quality, interoperability, and staff training… NOT just buying the next shiny platform. Implementing and adapting to AI takes time and has to be set up the correct way for each health system, otherwise it can lead to a negative impact on the hospital.
Tariffs, Inflation & Economic Turbulence
Global market shifts, including tariffs on medical equipment and rising supply chain costs, are impacting hospital bottom lines. The uncertainty of the impact that tariffs will have on each industry is frightening, but it’s something that RCMs have to brace for as the cost of goods is most likely to increase in the immediate future for all hospital systems.
Revenue cycle teams now have to think beyond billing and coding. Forecasting, financial strategy, and scenario planning are becoming part of the job.
Denials Are Skyrocketing
Payer complexity is at an all-time high. Prior auth requirements, constantly shifting policies, and opaque processes make managing denials a full-time effort.
Most hospitals saw denial rates above 20% in 2024, and those numbers continue to climb… costing each health system millions annually.
RCMs need strong analytics, payer negotiation skills, and proactive strategies to keep up.
Workforce Woes & Burnout
Staffing shortages are real. Skilled billers and coders are retiring or leaving, while burnout rates are climbing.
RCMs are being forced to do more with less, making automation, cross-training, and employee engagement top priorities.
Industry Instability & Rising Patient Expectations
Hospital closures, mergers, and financial strain, especially in rural areas, make planning difficult.
Meanwhile, patients are acting more like consumers: they expect price transparency, digital billing, and personalized service. RCMs are now on the frontlines of the patient experience, too.
The Bottom Line
Today’s revenue cycle leaders are no longer just process experts… they’re change agents, tech champions, and financial strategists, and much more. To succeed, they need to be agile, data-savvy, and always patient-centered. More than ever, RCM’s have a lot on their plate and less time to focus on every task they face.
ERISA Recovery’s advanced technology and team of experts can help decrease the level of stress for RCMs on some of the challenges above. We work behind existing resources and vendors to identify denied claims and appeal them on behalf of hospitals. No upfront costs or additional workload required!
Connect with us to learn how we can help create new streams of revenue for your hospital by winning back “lost revenue” from denied claims. You provide the reports and we do the rest!
