What Are the Top Revenue Leakage Points in RCM—and How Much Are They Costing Providers in 2025?
- Revenue Leaks Are Rising: In 2025, specialty practices lose 5–15%+ of income due to denials, under-coding, tech gaps, and poor patient collections — often amounting to $500K–$1M annually for a $5M practice.
- Top Leakage Sources: Major culprits include claim denials, missed prior authorizations, documentation errors, uncollected patient balances, aged A/R, and outdated systems.
- Hidden Drains: Many overlook deeper issues like lack of denial analytics, weak revenue integrity, poor forecasting, and limited automation—causing recurring losses.
- Cost Pressures Rising: Operating costs jumped ~11% year-over-year, forcing practices to generate 5–7% more gross revenue just to maintain margins.
- Fixes That Work (Practolytics-Style): Automate eligibility & prior auth, use root-cause denial management, conduct smart coding audits, improve patient communication, and modernize workflows.
- The Payoff: By plugging these leaks, specialty practices can recover 5–10%+ in lost revenue and move from survival mode to profitability in today’s tight-margin environment.