With ongoing concern about rural hospital closures, COVID-19 has resulted in even greater financial pressures. To learn more about what rural hospitals are facing right now, “our team took on a literature review,” says Anthony Slonim, MD, DrPH, FACHE, president and CEO of Reno, NV-based Renown Health.1

The revenue cycle “is so important a function for hospitals and health systems. Rural hospitals in particular are going to need to assure that their processes are tight,” Slonim says. To survive, rural hospitals must “tap into all potential sources of revenue and reimbursement in a timely way moving forward,” Slonim adds.

One way is through automation. “Rural hospitals benefit from embracing automation just as urban facilities do. But it’s the direct impact that can differ greatly,” says David Shelton, CEO of PatientMatters, a Firstsource company.

For rural hospitals, even minor increases in automation can lead to dramatic revenue cycle outcomes. These are two examples of how implementing even a single tool can produce a big return on investment for rural hospitals:

Automated price estimates. Some rural facilities rarely, if ever, communicate with patients about prices or billing. Automating estimates leads to higher collection rates for those hospitals since financial expectations are clear and accurate. “Staff is no longer hampered by paper-based processes,” Shelton explains. “In turn, quality and productivity improve, freeing up limited resources.”

Automated prior authorizations. “This is another area with big returns for rural hospitals with limited staffing resources,” Shelton offers.

Mostly, this is a manual process. Staff might spend much effort obtaining a prior authorization when it is not required, or overlook essential documentation and end up with a denial. “Any number of things can go wrong in the process without an established system,” Shelton observes.

As the number of services requiring prior authorizations rises, rural hospitals must make a choice. They can add staff, which is difficult because of employee shortages. “Like any business in rural America, specialized knowledge and expertise can be tricky to come by. The same is true for revenue cycle experts in rural healthcare,” Shelton says.

Rural facilities also lack enough patient volume to justify an expanded revenue cycle workforce. The other option is to automate prior authorization for fewer clerical errors and claims denials. “Few revenue cycle processes need improvement as urgently as prior authorization management,” Shelton says.


  1. Slonim AD, See H, Slonim S. Challenges confronting rural hospitals accentuated during COVID-19. J Biomed Res 2020;34:397-409.