Across every specialty, healthcare providers face a wide range of operational, financial, and legal challenges that affect how they deliver care and get reimbursed. From navigating complex billing systems to managing compliance and staffing issues, these hurdles can significantly impact practice performance and profitability. At MLM, we work with providers across various disciplines, helping them streamline operations, resolve disputes, and protect their revenue.
Below are 10 of the most common challenges healthcare providers face today—and how expert guidance can make all the difference.
1. Delayed or Denied Payments
Insurance carriers frequently delay or deny payments, citing issues like lack of medical necessity, incomplete documentation, or coding discrepancies. These delays put pressure on practice cash flow and increase administrative burdens.
Learn more: Denial on the Medical Basis
2. Complex Billing and Coding Requirements
Constantly changing CPT codes, modifiers, and payer-specific rules create room for costly errors. Accurate billing requires staff training, ongoing audits, and proper system support. Even small mistakes can lead to claim rejections.
3. Regulatory Compliance
From HIPAA to OSHA and state-specific medical board regulations, providers must meet a growing number of compliance standards. Falling short can result in fines, audits, or even loss of licensure.
4. Prior Authorizations and Utilization Review
Payers often require prior authorizations for treatment, leading to delays in care. UR processes—both prospective and retrospective—can challenge approved services, especially in workers’ comp claims, making timely documentation and follow-up critical.
Read more: Navigating UR Deferral Issues
5. Staffing Shortages and Burnout
The national shortage of qualified healthcare workers, paired with growing patient demand, has led to high burnout rates and increased turnover. This affects not only patient care but also operational efficiency.
6. Revenue Cycle Management Issues
Inefficient RCM processes can cause billing backlogs, missed reimbursement opportunities, and lost revenue. Without dedicated billing oversight, providers often struggle to keep up with denials, appeals, and collections.
7. Inconsistent Payer Policies
Private insurers, Medicare, and workers’ comp carriers all follow different rules. Providers must understand each policy’s unique requirements to ensure proper authorization, billing, and reimbursement.
8. Patient No-Shows and Cancellations
Missed appointments reduce revenue and disrupt scheduling. Many providers now rely on automated systems and reminder tools to reduce these disruptions, but the impact remains significant.
9. Rising Administrative Burdens
Non-clinical tasks—from credentialing to paperwork—are consuming more of providers’ time. A 2022 MGMA survey showed that over 40% of providers spend more time on administration than direct patient care.
10. Legal Disputes and Claims Management
From denied claims to lien disputes and malpractice issues, providers often face legal hurdles that require professional support. Without legal advocacy, resolving these issues can become a prolonged and costly process.
Learn more: Denial on the Legal Basis
How MLM Helps
At MLM, we partner with healthcare providers to overcome these challenges head-on. Our expert team handles billing, UR disputes, legal escalations, and compliance issues, allowing providers to focus on what matters most—delivering quality care.
Our goal is to streamline your practice operations and protect your revenue. With deep experience across workers’ comp, private insurance, and medical-legal billing, MLM ensures no money is left on the table.
Let us help you navigate the complexities of today’s healthcare landscape. Contact MLM today to learn how we can support your practice.pend more time on administration than direct patient care.
10. Legal Disputes and Claims Management
From denied claims to lien disputes and malpractice issues, providers often face legal hurdles that require professional support. Without legal advocacy, resolving these issues can become a prolonged and costly process.
How MLM Helps
At MLM, we partner with healthcare providers to overcome these challenges head-on. Our expert team handles billing, UR disputes, legal escalations, and compliance issues, allowing providers to focus on what matters most—delivering quality care.
Our goal is to streamline your practice operations and protect your revenue. With deep experience across workers’ comp, private insurance, and medical-legal billing, MLM ensures no money is left on the table.
Let us help you navigate the complexities of today’s healthcare landscape. Contact MLM today to learn how we can support your practice.
