Why Healthcare Providers Don’t Get Paid
This course explores why healthcare providers often fail to receive full payment for services rendered. It breaks down the healthcare revenue cycle and highlights common breakdowns that lead to denials, underpayments, and revenue loss.
Course Description
Getting paid in healthcare is far more complex than simply delivering services and submitting a claim. This course provides a practical, end-to-end look at the healthcare revenue cycle, showing how multiple steps, stakeholders, and systems interact—and where things commonly go wrong. From patient registration and insurance verification to documentation, coding, billing, and collections, you’ll gain a clear understanding of how breakdowns at any stage can impact reimbursement.
Through real-world examples and a structured walkthrough of common failure points, this course reframes claim denials as symptoms of deeper operational issues rather than isolated events. You’ll also explore how misaligned incentives, complex payer rules, and process inefficiencies contribute to revenue leakage. By the end, you’ll have a stronger grasp of how healthcare organizations can identify, trace, and address the underlying causes of payment issues to improve overall financial performance.
In this course, you'll learn...
Course Objectives
To identify the primary root causes of why healthcare providers fail to receive payment for services rendered
To explain how breakdowns in coverage, documentation, and billing processes impact reimbursement
To recognize how claim denials reflect underlying operational issues across the revenue cycle
To apply practical strategies to reduce denials and improve cash collections
How you'll apply these skills...
Identify Root Causes of Nonpayment: Trace denials and underpayments back to breakdowns in the revenue cycle
Improve Front-End Processes: Strengthen eligibility verification, authorization, and patient data accuracy
Enhance Documentation and Coding: Ensure clinical documentation supports accurate coding and reimbursement
Reduce Claim Denials: Recognize patterns and implement strategies to prevent recurring issues
Strengthen Billing and Follow-Up: Improve claim submission accuracy and ensure timely follow-up on unpaid claims
Use Denials as Insights: Leverage denial data to identify systemic issues and drive process improvements
Course Instructor
Michael Carroll, CPA, CISA, CISM
Michael is an accounting and information security professional. He is also an Adjunct Professor at several higher education institutions, where he is responsible for teaching various accounting and information technology courses.
Michael earned his MBA in Accounting and B.S. in Accounting / Accounting Information Systems from Canisius University. Additionally, Michael is a Certified Public Accountant (CPA) and a Certified Information Systems Security Professional (CISSP). Michael is a current member of the NYCPA’s Education Committee and has been an Advisory Board Member for the Academy of Finance (AOF) since 2020.
Michael enjoys traveling, hiking, and watching the Buffalo Bills. He has also participated in several marathon events.
Course Content
Additional Info
Format
5-20 min. videos, 4 quizzes, and a final assessment
Field of study
Specialized Knowledge
CPE Credits
CPEs 2.0
Prerequisites
Recommended completion of the foundational courses of Wisdify’s Healthcare Accounting Series.