Beyond Billing: How Revenue Cycle Management Can Protect Patients From Financial Surprises

“Unfortunately, when we see our patients, they're oblivious as to what their benefits are. They rely on us as the subject matter expert to really explain this to them.”

This is how William Borrego, VP of Revenue Cycle at PAM Health, describes the reality facing revenue cycle teams today: patients don't understand their insurance benefits, and when that gap isn't addressed upfront, it results in surprise bills months later. Revenue cycle management touches every stage of care, and when verification isn't done correctly, the downstream effects hurt both the organization and the patient.

Billing teams need analytics to catch patterns early and automation to streamline authorizations. Meanwhile, clinical appeals still need nurses to advocate for patients. Borrego shares his thoughts on preventing surprise bills, using AI thoughtfully to understand benefits, and why patient education defines modern revenue cycle management.