6 Medical Provider RCM for Complex Claims Challenges – and How Gain Can Help

In managing the revenue cycle for complex claims for a healthcare provider, any number of things can go wrong. Claims denial or reductions can cause revenue loss. Incorrect patient information can lead to issues down the road.  

Gain’s Saas-based, AI-enhanced third-party servicing platform has all the tools and resources you need to address any issues that come up during your revenue cycle management. From the moment patient information is collected and entered into your records to final payment.  

Let’s take a closer look at 6 medical provider RCM for complex claims challenges, and how Gain can help.

1. Collection Errors

Collection issues often arise from not following up on unpaid claims, not appealing denials in time, or failing to collect payment from patients. These errors can significantly impact a healthcare provider’s cash flow and financial health. 

How Gain Can Help: Gain collects, on average, nearly 900 basis points more than providers do when they self-service their own medical lien accounts. This reflects Gain’s effective collection process, which includes follow-ups on unpaid claims, timely appeals on denials, and efficient patient payment collection methods. Our medical lien collections and management services transfer the responsibility for negotiation and collection to the Gain team, significantly reducing collection errors and improving cash flow for healthcare providers. 

2. Tracking Medical Liens

Practice management software systems are not meant to manage Medical Liens, also commonly called a Letter of Protection (LOP). This forces practices to use excel spreadsheets to track medical liens which is cumbersome and consumes staff time. Using these manual workarounds makes it harder to avoid write-offs.  

How Gain Can Help: The Gain portal automates the process of tracking medical liens and the progress of personal injury lawsuits with medical lien balances. By relying on Gain to manage the medical lien, you save staff time and can convert medical liens from a potential loss into increased revenue for your practice.  

3. Communicating with Attorneys

Holders of medical liens must be in constant contact with attorneys, paralegals, and case managers for case updates, underwriting information, cases, settlement amounts, and timing of payments.  

How Gain Can Help: The Gain platform is a single portal where both healthcare providers and attorneys can provide updates, upload critical documents, and send messages, streamlining the process of communication, improving inefficiencies with your staff, and eliminating delays involved in tracking down information and trying to figure out who to contact for different needs via phone calls or emails.   

4. Judicial Risks

Getting payment on a medical lien depends in large measure on what happens inside a courtroom and healthcare providers may feel powerless to affect the outcome they want.  

Providers risk not meeting technical requirements for liens, and keeping track of what those requirements are can be a daunting task, as they vary by state. They also risk dealing with the perception that they are in “cahoots” with attorneys or inflating bills for higher settlements. 

How Gain Can Help: By using Gain’s platform to automatically track and manage your medical liens and handle related communication and sharing of documents with attorneys, you can significantly reduce your risk.  

Gain’s Provider Map locates providers based on the patient’s location, rather than personal relationships. This can help ensure that providers are chosen based on their proximity and availability, rather than any perceived favoritism with attorneys. 

5. Insurance Defense Challenges

Defense counsels frequently challenge the independence of doctors, and question the necessity of treatment, the reasonableness of medical bills, and the validity of liens in litigation on the basis of what they assert is the provider’s bias due to their vested financial interested. The information needed to be gathered when seeing personal injury patients who have no health insurance potentially biases doctor’s professional opinions. 

How Gain Can Help: By outsourcing the entire process of servicing medical liens and medical liens to a third-party platform, you can make such legal challenges moot. This allows you to focus on providing the treatment that is needed to your patients, without having to worry about financial ins and outs of how you will be eventually paid.  

In addition to technological solutions, we aim to empower physician practice groups facing ongoing declines in reimbursement rates from government and commercial payers, leveling the playing field against the sophisticated and powerful third-party liability carriers in healthcare insurance. Complex claims take on average about 1 and a half years to resolve. Given that not all claims result in payouts, this cap is unsustainable. 

As co-founders of Americans for Patient Access (APA), the best practices organization committed to maintaining access to quality medical care for all patients regardless of payor source, we are supporting nationwide lobbying efforts to educate legislators on the necessity of access to care for the less advantaged, while ensuring fair reimbursement for providers. 

6. Lack of Data-Based Insights

Without data, you can’t reliably forecast how much you can expect to receive in payment, how quickly you can expect funds to be made available, or what your overall flow of revenues should be in a given period or from a particular law firm. In effect, you are flying blind.  

How Gain Can Help: Gain’s AI-enhanced platform provides you with the business intelligence reporting necessary to track the progress of cases and the timing of settlements, payoffs, and the resulting impact on cash flow. Our AI-enhanced reports can inform your decisions on referral sources, case financials, and more. 

Just about anything can go wrong in your revenue cycle, from lack of data, to lost revenues due to medical liens or legal challenges. By helping you to track documents, and the progress of cases, communicate more effectively with other involved parties, and access key data and reports, Gain can transform your revenue cycle management for complex claims, reducing risk while boosting revenues.  

Talk to a Gain specialist or request a consultation today. 


Medical Funding

Medical Liens

Pre-Settlement Funding

Legal Funding


Letter of Protection