Payer-specific review
When it may fit: A few payers account for most of the slowdown.
Evidence needed: Payer rules, portal changes and denial detail.
Trade-off: Needs payer cooperation.
Hospital Intelligence Brief
How to Identify Potential Bottlenecks in the Revenue Cycle
Cash arrives slowly when something in the chain slows it. Days in accounts receivable by payer is one of the clearest places to see where.
1. The business problem
Where in the revenue cycle is cash getting stuck?
The revenue cycle runs from scheduling to final payment, with many handoffs. When a step slows, cash is delayed, and the effect shows up as rising days in accounts receivable. But the total hides which step slowed, and which payer is responsible.
This matters because slow cash is a financial cost: borrowing, or reduced liquidity. In a hospital with thin cash, a few extra days in A/R can matter a great deal.
2. What the evidence can reveal
To find a bottleneck, break the delay down:
- Calculated Days in A/R overall and by payer.
- Calculated Denial rate by payer: denials add weeks.
- Information gap By stage: registration to claim submission, submission to payment, denial to resolution.
- Information gap Work in progress: claims waiting on documentation, coding or authorization.
Public benchmarks for days in A/R exist, but they differ by definition and payer mix. Compare a hospital with itself over time first.
3. Investigate the problem
In the synthetic hospital, days in A/R rose from 43.9 days to 47.5 days. Illustrative By payer the slowdown is uneven:
| Payer | Denied % of billed FY25 | Denied % of billed FY26 | A/R days FY25 | A/R days FY26 |
|---|---|---|---|---|
| Medicare | 7.9% | 8.4% | 38.0 days | 40.0 days |
| Medicaid | 12.0% | 14.4% | 44.0 days | 50.0 days |
| Commercial A | 10.0% | 12.7% | 40.0 days | 47.0 days |
| Commercial B | 10.4% | 13.0% | 42.0 days | 52.0 days |
| Self-pay & other | 13.0% | 11.2% | 52.0 days | 55.0 days |
Calculated Commercial B slowed most (A/R days from 42.0 days to 52.0 days) and its denied share rose to 13.0%. Commercial A and Medicaid moved in the same direction. Medicare barely changed. The delay is concentrated with specific payers, which suggests payer-specific rules or processes, not a hospital-wide problem.
Hypothesis Payers where denials rise and cash slows together often changed a rule, a portal or an authorization requirement. That suggests a payer-by-payer conversation and a look at the relevant workflow, rather than general pressure on staff.
4. Explore the interactive experience
Investigate it yourself.
Revenue Cycle Investigation: a claims dashboard with denial reasons, payers and A/R days, a denial-reduction scenario that separates possible exposure from verified revenue, evidence-linked answers from APIS, and a sample brief, all on synthetic data.
The experience below uses synthetic claims data for a fictional hospital. No patient data is involved, and every figure is illustrative.
- Sort the payer table by A/R days. Which payers are slowest and which slowed most?
- Compare denied share and A/R days for each payer: do they move together?
- Ask APIS which payers warrant a closer review.
5. Evaluate possible solutions
Payer-specific bottlenecks need payer-specific responses.
6. What leadership should do next
Questions to answer
- Which payers are slowest and which slowed most?
- Where in the process does the delay occur?
- What changed?
- What is the cash cost?
Data to gather
- A/R aging by payer
- Stage-by-stage timing
- Work-in-progress aging
- Payer contract timeliness terms
Steps to take
- Map A/R days by payer.
- Trace the largest slowdowns to stages.
- Engage payers on specific issues.
- Track weekly until days stabilize.
7. Engage Two Pillars
Explore Your Hospital’s Opportunities
Two Pillars can help hospital leadership investigate financial, operational, and strategic questions using relevant organizational data, public information, and a structured assessment process. A good first step is an A/R and cash-flow bottleneck analysis by payer and process stage.
Sources and data notes
- The organization, its figures, and every number in this article and its interactive experience are synthetic and illustrative. They are not real data, a benchmark, or a forecast.
- CMS, Cost Reports: www.cms.gov/data-research/statistics-trends-and-reports/cost-reports — public information on the annual cost reports that Medicare-participating hospitals file.
- Maryland Health Services Cost Review Commission: hscrc.maryland.gov — published Maryland hospital financial and utilization data.
- Reviewed October 2026. This article describes an approach to investigation. It does not replace review by qualified professionals.