Unlocking Hidden Revenue in Rural Hospitals: Start with Charge Capture

By Taylor Searfoss, MSPH, FHFMA, VP of Business Development, Ni2 Hospital Division, Infinx

Over 50% of rural hospitals operate at a loss—but the revenue to turn things around is already within reach.

Rural hospitals across America are facing a financial crisis. Over half are operating in the red, and hundreds are at risk of closure. Contributing factors include limited technology, workforce shortages, and complex payer requirements. Yet hidden within their current workflows are millions in missed revenue—just waiting to be captured.

The good news? These leaks can be stopped.

By focusing on strategic revenue cycle management (RCM)—especially charge capture optimization, the single biggest source of potential lift—rural hospitals can stabilize operations, reclaim lost revenue, and ensure long-term sustainability.

The Core Challenges Draining Revenue

Rural hospitals face unique pressures that make optimizing the revenue cycle challenging:

Staff Bandwidth Constraints: Operational demands leave little time for proactive RCM efforts.
Limited IT Resources: Many hospitals lack the systems or support to identify revenue leakage.
Payer Complexities: Denials, prior auth hurdles, and slow reimbursements disrupt cash flow.
Charge Capture Gaps: The most costly oversight—missed billing due to workflow or EHR limitations.

While all these barriers matter, charge capture is the most immediate and impactful place to start.

Charge Capture: The #1 Hidden Revenue Opportunity

When hospitals fail to bill for every reimbursable service they provide, they leave money on the table—often unknowingly.

Did you know? Studies show 90–95% of potential revenue lift in rural hospitals comes from outpatient claims, making charge capture the largest and most addressable opportunity for financial improvement.

Commonly missed charges include:

Emergency department services
Outpatient surgery
Imaging
Bundled supplies and injectables
Physical and Occupational Therapy

Solution: Go beyond just catching errors before claims go out the door—focus on eliminating the root cause of charge capture misses.

That means:

Identifying where in the workflow charges are being dropped or miscoded
Re-training staff on documentation standards
Reconfiguring EHR and billing system logic to align with actual clinical practice
And yes, using technology-backed charge capture audits as a safety net—but not the only line of defense

By addressing root causes rather than just cleaning up downstream issues, hospitals create sustainable improvements in revenue integrity. The result? Fewer errors, faster payments, and less reliance on reactive tools to plug revenue leaks.

Additional Areas for Revenue Recovery

After charge capture, other RCM improvements still offer meaningful gains:

Billing & AR Follow-Up

Problem: 30–40% of rural hospitals struggle with AR follow-up.
Solution: Augment internal teams with external RCM partners to accelerate collections and reduce aging.

Denial Management & Prior Authorizations

Problem: Less than 25% of rural hospitals have a proactive denial prevention strategy.
Solution: Use denial analytics and automation tools to flag trends and resolve issues before claims are denied.

Strategic Pricing & Payer Contracting

Problem: 80–90% of hospitals lack structured pricing strategies.
Solution: Benchmark fee schedules and renegotiate payer contracts to ensure competitive reimbursement.

Technology Is the Multiplier

Modern RCM solutions aren’t about replacing staff—they’re about making them more effective. Key tools include:

AI-Driven Charge Capture: Automates identification of missing codes.
Predictive Denial Analytics: Flags denial trends before claims are submitted.
Automated Prior Auth Tools: Streamlines approvals, reduces delays.
Seamless EHR Integration: Ensures accuracy and efficiency across systems.

Case Study: $2.3M Recovered in One Year

A rural hospital with mounting denials and charge capture issues partnered with an RCM vendor to implement:

Charge capture audits for outpatient services
Denial management automation
Targeted AR strategies

The results:

$2.3M in recovered revenue
40% improvement in claim accuracy
20% faster reimbursement turnaround

Overcoming IT Gaps with the Right Partners

Many rural hospitals lack the internal bandwidth to implement advanced RCM tools. But they don’t have to do it alone.

Solution: Partner with RCM experts who can manage the technical lift—seamlessly integrating with your existing systems and allowing your team to stay focused on patient care.

The Path Forward

The fastest way to make a financial impact is to start with charge capture. From there, hospitals can build momentum with AR follow-up, denial management, and strategic pricing.

Rural healthcare doesn’t have to be a story of scarcity. With the right RCM strategies—and partners—it can be a story of smart recovery and long-term sustainability.

Learn more at: www.ni2health.com

Request a personalized RCM assessment from Taylor Searfoss

Taylor Searfoss serves as Vice President of Business Development at Ni2 Health, hospital division of Infinx, where he leverages extensive experience in healthcare administration, sales strategy, and revenue cycle management. He began his career in hospital-based revenue cycle operations before transitioning to the business partner sector, where he has continued to drive value for healthcare organizations through innovative solutions and strategic collaboration. Mr. Searfoss is a Fellow of the Healthcare Financial Management Association (HFMA) and holds a Master of Public Health Administration from Meharry Medical College.