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The Rural Health Roadmap Series
October 13, 2025

A Practical Guide to Maximizing RHC Reimbursements

Overcoming the Top Financial Challenge for Rural Health Clinics

Practice Manager reviewing positive reimbursement dashboard

Financial stability is a primary concern for most Rural Health Clinics (RHCs). A recent survey confirmed that declining reimbursements, improving the billing process, and managing denials are among the top challenges RHCs face. While our primary focus is on RHCs in Arkansas, Louisiana, Oklahoma, Texas, Mississippi, and Alabama, mastering the revenue cycle isn't just a goal—it's the key to survival for RHCs across the nation.

Successfully navigating these complexities is essential. The right EHR technology can make a significant impact in successfully navigating RHC billing. Studies show RHCs can achieve a 30% reduction in time spent charting. But you need the correct information and tools to focus on revenue-generating activities. Our guide breaks down eight proven best practices to enhance efficiency, minimize errors, and optimize your reimbursements.

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Eight Best Practices for a Healthier Revenue Cycle

1. Perfect Your Patient Registration and Financial Workflows

A clean claim starts at the front desk. A best-in-class process for any clinic includes mastering the fundamentals: 

  • Verify Eligibility and Benefits: The right clearinghouse streamlines staff workflows by confirming active insurance coverage, verifying the existence of advantage plans, and coordinating benefits for every patient at every visit, thereby preventing downstream denials.
  • Collect Accurate Demographics: Utilize OCR-enabled technology to ensure that all patient information—name, date of birth, and address—is accurate and up-to-date in your system.
  • Collect at Time of Service: Collect all known co-pays, deductibles, and outstanding balances from the patient before they leave the clinic.

For RHCs, this process has two additional critical steps to maximize reimbursement:

  • Complete the MSP Questionnaire: Incorporate a digital Medicare Secondary Payer (MSP) Questionnaire into your EHR and ensure it's completed at each relevant visit.
  • Collect Medicare Deductibles: Proactively collect Medicare deductibles upfront, especially early in the year, to reduce the amount that ends up as bad debt. Train your staff on how different supplemental plans affect the patient’s annual deductible. 

2. Train Clinicians for Effective Charge Capture

Capturing charges wholly and accurately is foundational to a healthy revenue cycle. Provide training to your clinicians on documenting all services provided during an encounter. For RHCs, this means understanding how to accurately document all billable encounters, including qualifying visits, ancillary services, and minor procedures.

A key part of this process is ensuring that the clinical documentation is complete, as it serves as the primary source for all billing. This is where AI-assisted documentation tools can have a significant impact. By creating comprehensive notes in real-time, these tools help ensure that all billable services are documented, leading to more accurate charge capture and allowing providers to focus on patient care. 

Insight: Understanding Your RHC's Cost Structure

Did you know that the cost structure for a typical RHC is approximately 90% fixed (salaries, benefits, overhead) and only 10% variable (supplies, medications)?

This means that after you've covered your fixed costs, a significant portion of the revenue from each additional visit goes directly to your bottom line. That's why maximizing reimbursement on every single claim is crucial to an RHC's financial sustainability.

3. Optimize Claims Management

RHCs face unique and complex challenges with billing, coding, and splitting claims that standard systems often struggle to handle. A successful RHC claims process starts with mastering universal best practices: 

  • Scrub All Claims: Before submission, "scrub" every claim to check for common errors in patient data, procedure codes, and diagnosis codes to ensure it is "clean."
  • Ensure Timely Filing: Submit all claims well within each payer's deadline to avoid simple, unnecessary denials for late filing. For RHCs, Medicare claims generally have a one-year filing limit (42 CFR § 424.44), but deadlines for other payers and states can vary, requiring careful attention to specific requirements.

For RHCs, managing the claims process involves additional layers of complexity that require specific attention: 

  • Update Bundling Settings: Regularly update Medicare and Medicaid bundling settings within your billing software to ensure accuracy and compliance.
  • Automate RHC Edits: Use claim edits to automatically catch missing CG modifiers and specific codes that need to be split onto a separate claim.
  • Develop Split Billing Workflows: Create clear, repeatable workflows for split billing that adhere to Medicare and Medicaid guidelines.

4. Streamline Payment Processing

Efficient payment processing is key to maintaining a healthy cash flow. For any practice, this means establishing a prompt and accurate workflow for: 

  • Posting Payments: Promptly post all Electronic Remittance Advice (ERA) files and other payments from payers to the correct patient accounts.
  • Reconciling Payments: Regularly reconcile posted payments against bank deposits to ensure all funds are accounted for and identify any discrepancies.

During this process, RHCs must be vigilant about two unique and costly issues: 

  • Monitor for Withholdings: Scrutinize your ERAs for penalty withholdings. Medicare/Medicaid may halt payments if cost report submissions are late, and these often appear as $0.00 payments that can be missed.
  • Verify Your AIR Payments: Confirm that Medicare Advantage plans are reimbursing at your All-Inclusive Rate (AIR)—the per-visit, cost-based payment to which you are entitled. If they are not, you must send them your AIR rate letter to confirm your RHC status.
By the Numbers: Accelerate Your Cash Flow 

A third-party study found that RHCs using the Azalea Health EHR saw an average 10% reduction in their days in Accounts Receivable. This tangible improvement directly accelerates a clinic's cash flow and strengthens its financial stability by ensuring that payments are collected more efficiently.

5. Master Denials and A/R Follow-Up

An effective denial management strategy encompasses both prevention and resolution, and it begins with data. Best practices include consistently tracking your denial rate and analyzing the root causes of your most common denials.

The process begins with consistently tracking your denial rate and analyzing the root causes of your most common denials, as coding errors account for up to 75% of preventable claim denials. Modern EHRs, such as Azalea Health, now include AI-powered tools to address this issue proactively. The goal is to significantly improve the revenue cycle by identifying errors before submission and automating the status tracking process. On average, Azalea clients using the AI-powered Billing Assistant see 68% more first-pass claim approvals and spend 66% less time on manual follow-ups. 

6. Be Consistent with Patient Collections

A proactive and patient-friendly collections process is essential for a healthy cash flow. Best practices for any clinic begin with clear communication and making it easy for patients to pay: 

  • Establish a Clear Financial Policy: Develop a written policy that outlines patient financial responsibilities and review it with every new patient.
  • Provide Pre-Service Estimates: Utilize tools like a patient estimator to inform patients of their expected out-of-pocket costs before their visit, which increases the likelihood of payment.
  • Prioritize Time-of-Service Collections: Your highest chance of collecting a patient's balance is while they are in the office. Make it a standard practice to collect all co-pays and known deductibles at check-in or check-out.
  • Offer Multiple Payment Options: Make it easy for patients to pay via an online patient portal, by setting up payment plans, or by keeping a credit card on file.

During this process, RHCs must be vigilant about two unique and costly issues: 

  • Document Efforts for Medicare Bad Debt: To claim reimbursement for uncollected Medicare deductibles and coinsurance, you must prove a "reasonable collection effort." A formal process of sending regular, consistent patient statements provides the necessary documentation to support these claims.
By the Numbers: Giving Providers Back Their Time

The same study found that RHCs using the Azalea Health EHR reduced the time providers spend on charting by 30%. This significant efficiency gain is a direct solution to clinician burnout, allowing providers to focus more on patient care during the day and spend less time on after-hours documentation. Faster, more accurate charting also leads to quicker claim submission, positively impacting the entire revenue cycle.

7. Improve Account Management

Proactive account management involves establishing a routine for reviewing your Accounts Receivable (A/R) aging reports to identify and resolve issues before they impact your cash flow, and then following up on unpaid claims with payers.

For RHCs, this process includes several unique high-value activities: 

  • Rigorously Manage Credit Balances: You must regularly identify and resolve credit balances to ensure the timely completion of the quarterly Medicare Credit Balance Report.
  • Reconcile All Charges: Reconcile documented services against posted charges, paying special attention to non-office visit encounters like nursing home rounds, to ensure every qualifying service is captured and billed.
  • Track Vaccine Administration: Track all vaccine and administration charges throughout the year. Although not billed directly for an encounter payment, this data must be accurately compiled to ensure 100% reimbursement of reasonable costs on your annual cost report.

8. Leverage Reporting and Analytics

You can't manage what you don't measure. The foundation of a high-performing revenue cycle is the use of advanced data analytics to track Key Performance Indicators (KPIs), analyze trends, and benchmark your performance against industry standards.

For RHCs, this data-driven approach is not just a best practice—it's essential for your most critical financial requirements: 

  • Ensure Accurate and Timely Cost Reporting: The annual cost report directly impacts your reimbursement rates. An integrated analytics tool helps you consolidate the necessary data—such as qualifying visit counts and provider productivity —minimizes manual effort and ensures accuracy.
  • Drive Performance Improvement: Use your analytics to monitor trends in your clean claim rate, A/R days, and denial rate. This enables you to pinpoint the root cause of problems and make informed, data-driven decisions to enhance your clinic's financial well-being.

Preparing for Future Reimbursement Challenges:

The OBBBA

The One Big Beautiful Bill Act (OBBBA) could potentially result in up to 2.7 million people in rural areas losing Medicaid or ACA coverage, which would directly impact your payer mix and revenue. To help providers navigate these changes, the bill also established the Rural Health Transformation (RHT) Program, a $50 billion fund designed to support rural clinics.

A critical first step in preparing for these shifts is to conduct a payer mix analysis. By calculating the percentage of your visits and reimbursements that come from Medicaid, you can model the potential financial impact and develop strategies to mitigate revenue loss. 

The Oasis Partnership:

Local Support & Proven Results

Oasis Medical Solutions provides on-site implementation, training, and support for RHCs across our mid-south service area, as well as efficient remote services for all our practices nationwide.

Implementing best practices is much simpler with the right technology and a supportive partner. A third-party study of RHCs using the Azalea Health EHR found that clinics achieved significant, measurable results: 

  • 30% Reduction in time spent charting, giving providers back valuable time to focus on patient care and reducing burnout.
  • A 25% Reduction in time spent registering patients, resulting in a smoother front-office workflow and an improved patient experience.
  • 10% Reduction in days in A/R, which directly accelerates your clinic's cash flow and improves financial stability.

Individually, these are significant improvements. Together, they represent a transformation in your clinic's operational efficiency and financial health, allowing your team to focus on your primary mission: patient care.

As your value-added reseller, the Oasis Medical Solutions team provides the on-site, personalized training that RHCs in Arkansas, Louisiana, Mississippi, Oklahoma, Alabama, and Texas need to turn these best practices into their daily reality. We ensure your team is confident and your technology—including powerful tools like the AI-powered Billing Assistant—is optimized for success. 

Want more information on Rural Health?

Visit our page on Rural Health Clinic Solutions →

We look forward to connecting with you online!

Oasis Medical Solutions is a trusted partner for healthcare practices, offering comprehensive services and support for Azalea Health's suite of electronic health record (EHR) and practice management solutions. Focusing on personalized implementation, training, and ongoing support, Oasis Medical Solutions helps clients optimize their technology to improve efficiency and deliver exceptional patient care.

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Who is 
Oasis Medical Solutions

Oasis Medical Solutions is a healthcare technology company that helps medical practices streamline their operations and maximize revenue. We specialize in providing Electronic Health Records (EHR) systems and related services, including practice management software, billing solutions, and consulting.

With a focus on personalized service and customized solutions, Oasis aims to empower healthcare providers to navigate the complexities of the healthcare industry and focus on delivering quality patient care.

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April 17, 2025

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