How Providers Safeguard Their Revenue Cycle in the ‘Big Beautiful Bill’ Era

The One Big Beautiful Bill Act has officially been signed into law. Congressional Budget Office estimates indicate the bill will slash more than $1 trillion from healthcare over the next decade and increase the number of people without health insurance in 2034 by 10 million, according reports from the Center for Medicare Advocacy and the Kaiser Family Foundation.  

Many people already are struggling to pay for healthcare. Last year alone, Americans borrowed $74 billion to cover medical costs (West Health-Gallup Healthcare Survey, 2024). And with cuts targeting Medicaid, providers serving vulnerable populations will face sharp pressure. In this new era, revenue cycle performance isn’t just an administrative task, it’s a lifeline.  

To not only survive but to sustain exceptional patient care and financial success, providers must move from reactive billing to proactive revenue cycle management (RCM). The data doesn’t lie, and it’s your clearest indicator of operational health. RCM is no longer just about claims processing — it’s the story of your practice’s viability. 

A key part to effective RCM is identifying errors and inefficiencies that have gone unrecognized and are costing your practice money. So where does the revenue leakage start? Everywhere — if you’re not paying attention. Here’s what you must monitor from patient intake to final reimbursement: 

• Ensure every insurance encounter results in a submitted claim. No claim, no payment.
• Review and update fee schedules regularly. Outdated rates = lost revenue. That means you should update your CDM and master files without delay.
• Timely filing is essential. Most payers have strict deadlines; miss them, and you’re writing off revenue.
• Verify LCD (Local Coverage Determination) requirements. Avoid denials before they happen.
• Use modifiers correctly. Incorrect use can trigger rejections or underpayment.
• Have airtight processes for prior authorizations and pre-certifications.
• Ensure robust clinical documentation. It’s not just for quality care — it protects your reimbursement.
• Double-check laterality on claims. Left vs. right errors can stall or forfeit payment.
• Track Average Sales Price (ASP) changes quarterly. Especially for drugs and biologics.
• Bill the correct number of units. This is often overlooked and leads to underbilling.
• Secure proper reimbursement for donor corneal tissues and other specialized services.
• Monitor contract compliance. Payers often underpay against agreed terms — don’t let it slide.

But even with all this, the old ways won’t cut it. Excel sheets and manual audits can’t keep up with the complexity of today’s revenue cycles. Your practice should leverage the latest technology to amplify your RCM efforts. Artificial intelligence is not optional, it’s mission critical. From predictive analytics to real-time denial management, automation allows you to surface issues before they cost you. Machine learning can flag mismatches in coding, missing documentation, or changes in payer behavior — long before a denial ever hits your desk. 

What’s at stake isn’t just lost revenue, it’s lost care. Providers are not just businesses; they are lifelines for communities. But you can’t provide care if your practice can’t pay its staff or keep its doors open. You need to see every transaction as a piece of your survival plan. 

And remember that $74 billion Americans borrowed last year? Every missed charge, every denial, and every slow claim adds to that national burden. Providers must lead the way in reversing that trend: not by cutting care, but by mastering the business of healthcare. Do that, and you don’t just survive, you ensure your patients don’t end up paying twice — once at the clinic, and again through medical debt. 

Join Nextech’s RCM experts on Aug. 18, for a deeper dive into revenue leakage prevention. You’ll learn how specialty practices can protect financial stability and strengthen long-term success by shifting from reactive billing to proactive, data-driven revenue cycle management — using analytics to identify and prevent revenue leakage before it happens. Register for the “Safeguard Your Practice Against Revenue Leakage” webinar today. 

About the Author 

Nio Querio, Nextech RCM Advisor, has 30+ years’ experience in Revenue Cycle Management for Manager Hospital Systems, PHOs, ASCs, Large Specialty Provider Groups and Primary Care Organizations. Nio was named as one of the Top 25 Innovators of 2021 by “Modern Healthcare.” She previously served as the SVP of Revenue Cycle at Tufts Medicine and currently serves as the Fractional Chief Strategy Officer at Nashville General Hospital.