What Nobody Tells You About RCM

Addie Bender, Dir. of RCM Services, talks RCM realities translating complexity and chaos to solutions.

I’m going to state something obvious: your business requires healthy revenue streams for sustainability. Revenue Cycle Management, especially in behavioral health, exists in a delicate balance: navigating the payer landscape, providing quality care, surviving audits, knowing when to fight and when to retreat. Where what you don’t see is costing you, what you do see might only be part of the picture, and the rate of change moves at the speed of light.

But I’m going to let you in on a secret…

1. RCM isn’t billing. It’s your ecosystem.

Think RCM is just claim submission and follow-up? I’ve got news for you…

It’s:
• How you train your new hires
• How strategically you utilize our key functions: insurance cards, funding cards, client balances
• Whether your documentation templates are service specific
• Whether your platform auto-validates claim structure or just spits out rejections

Most RCM disasters are actually clinical, operational, or licensing breakdowns in disguise.

That’s why our team at Noteable doesn’t just bill for partners. We empower them.

And when the disaster happens on the payer side? We’re citing every line from the state code, pulling their provider manuals, using years of expertise to craft our escalation strategy. Advocating for you and your financial health.

(Ask me how I know.)


2. Your biggest losses aren’t denials — they’re what never made it out the door.

One of the most painful realizations I’ve had? The scariest losses aren’t in your denial report. They’re in your no-submission bucket:
• Claims stuck in purgatory—
• Services never linked to payers at the right rate
• Staff who weren’t credentialed but kept seeing clients anyway

I’ve seen hundreds of thousands of dollars vanish not because someone made a mistake…but because no one noticed.

This is why we built our “Unpaid Claims” tool (and a dashboard to go along with it)….what you don’t see is costing you. And you deserve transparency.


3. Confusion and chaos have become a hallmark of the insurance payer landscape. And things aren’t getting simpler.

If your team is constantly Slacking you about whether 90837s need a modifier, or if they can bill H0015 without prior auth — the issue isn’t them.

It’s:
• Disconnected internal workflows
• Tools that don’t talk to each other (hello, payer portal + random pad of paper + Slack + 4 other tools)
• Constantly shifting payer rules no one documented
• Leaders who don’t know where things are breaking down across clinical, ops, and billing

When we onboard new partners at Noteable, we don’t just collect their credentials.
We audit their entire operating nervous system.
Because when no one owns the revenue process end to end? Everyone’s job becomes harder. And no one gets paid on time.


4. There is no net neutral when it comes to RCM.

You want to know how I know RCM isn’t just admin work?

Because I’ve:
• Held space for providers trying to stay afloat while Medicaid audits collapse their cash flow
• Been in the trenches with ABA practices losing $40K in one month from payer credentialing delays
• Watched DBHDS redefine licensure mid-year while MCOs recouped money retroactively

RCM is a justice issue. RCM is whether you can afford to keep showing up for your clients.


5. It’s the why that matters. And without the why, no billing team, coder, or AI agent can save you.

Remember what I said about RCM being an ecosystem? Let’s flesh that out a bit more. Here’s where I see things break down:
• Late case notes = late claim submissions
• Forgetting rendering providers are required for this service with this payer, but not with this service for this other payer
• Using old service codes that are no longer valid with the MCO

That’s why we bring on our new RCM partners with an intentional, guided onboarding period—we make sure you know the why, not just the what, so you can workshop up front processes to support getting paid the first time, not months later.


6. Great RCM isn’t loud. It’s invisible.

When RCM works, no one’s talking about it. Because:
• Claims go out on time.
• Denials are low and understood.
• ERAs auto-post.
• Providers know what to do.

At Noteable, we aim to be seen, not heard. That means every claim is a whisper, not a fire. Your task queue is tidy, not stacked in your inbox.

So.

If you’ve ever felt like it shouldn’t be this hard—you’re right.

If you’ve ever felt like you’re the only one asking how your $2M-a-year practice still has no real RCM oversight…you’re not alone. And if you’re brand new to the industry, wondering how you’re ever going to make this work financially because you don’t know the first thing about billing? Nope, not alone.

And if you’ve ever wanted someone who knows you, your industry, and builds scalable solutions to solve your deepest pain points?

That’s what we’re building at Noteable.

Because what nobody tells you about RCM…is that it’s everything. So you can focus on delivering better care.

Want to see where Elite can make the difference in your revenue cycle? Lets talk.

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