Navigating Year-End Challenges: RCM Priorities for Texas Healthcare Leaders

As the fourth quarter accelerates, revenue cycle leaders across Texas face mounting pressures—from hitting end-of-year revenue targets to preparing for 2026 payer contract updates, compliance reviews, and workforce retention. November is a pivotal month, and how we navigate it can make or break financial performance.

1. Reconcile Denials and Aged AR Before the Clock Runs Out

Don’t let old claims follow you into Q1. Focus your teams on:

• High-dollar, aged AR: Prioritize clean-up and root cause analysis.

• Denials by category: Target preventable patterns (e.g., eligibility, authorization).

• Payer-specific escalations: Use Q4 meetings to resolve backlog issues with payers, especially Medicaid MCOs and Medicare Advantage plans.

2. Prep for Payer Fee Schedule and Contract Changes

Texas-based payers often release updates effective January 1. Now’s the time to:

• Review fee schedule adjustments for top commercial payers.

• Conduct impact modeling to assess revenue at risk by CPT and DRG.

• Align with contracting, legal, and revenue integrity to confirm readiness in your CDM and billing systems.

3. Ensure Compliance Readiness Before the New Year

Many hospitals and physician groups will undergo compliance audits early next year. Use November to:

• Review HIPAA, CMS, and OIG requirements.

• Audit high-risk billing areas (e.g., observation, modifiers, telehealth).

• Ensure CCT training is completed if you leverage it for CMS or TJC compliance.

4. Re-Engage Your Front-End Teams

Q4 burnout is real, especially in patient access. Reinforce:

• Insurance verification and authorization accuracy

• POS collections coaching

• Recognition efforts to boost morale during peak holiday staffing challenges.

5. Close the Books with Integrity

Work closely with finance on:

• Contractual allowances and bad debt reserves

• Final cash posting and adjustment accuracy

• Reconciling payer withhold or risk-sharing payments

Final Thought: November Is for Leadership

This is not the time to just "get through" the year. Texas RCM leaders have an opportunity to lead intentionally, close the year strong, and lay the groundwork for strategic innovation in 2026.

Let’s model the kind of leadership our teams—and our industry—need right now.