![Two clinicians reviewing a chart on a tablet](https://cdn.truenextglobal.com/wordpress/uploads/2026/10/12152856/vertical-healthcare.webp) [Home](/)/[Industries](/industries/)/Healthcare operations Industry brief 01 of 04 ยท 9 minute read # We work the claims, your clinic keeps moving Revenue cycle and clinical administration as a practice manager meets them today, what the published numbers say about the pressure, and why a dedicated team in the Philippines is the practical answer. Every figure links to the organisation that published it. ## How the work runs today Here is revenue cycle and clinical administration as a practice manager meets it today, and the part a dedicated offshore team takes on. Every figure links to the organisation that published it. ### One claim in nine comes back About one claim in nine returns denied on first submission. Appeals overturn a little under half of those, and the revenue that stays out rose a quarter in a single year to 48.4 billion dollars. Almost all of that increase sits in clinical denials and requests for information, which are the ones where a person opens the chart, finds the support and writes the case. Initial denial rate 11.6 per cent, final denials and bad debt $48.4bn: [Kodiak Solutions, 2025](https://businesswire.com/news/home/20260331038554/en/) ### Prior authorization takes a day a week Forty requests per physician per week and thirteen hours of physician and staff time. Two practices in five employ somebody dedicated to prior authorization alone, so the queue waits on one person whenever that person takes leave. Payers meet new decision deadlines from January 2026, and the interfaces that automate the exchange go live in 2027. Forty requests and thirteen hours a week, 1,000 physicians surveyed: [American Medical Association, 2025](https://www.ama-assn.org/system/files/prior-authorization-survey.pdf) ### Credentialing holds revenue in the queue A third of provider organisations wait thirty to forty-five days for enrolment and nearly a fifth wait sixty days or more. Eighty-three per cent run it in-house on manual workflows, and half of those teams lost somebody in the past year, so files change hands mid-application while the clinician already sees patients. Enrolment delays and manual workflows, 507 provider organisations: [Medallion, 2025](https://www.prnewswire.com/news-releases/slow-credentialing-and-enrollment-are-draining-revenueand-most-healthcare-teams-arent-tracking-the-loss-according-to-medallion-report-302352239.html) ### Pay climbs faster than the roster grows Hiring grew harder for fifty-six per cent of practices over the past year. Medical receptionist pay rose twenty-two per cent in five years, and operating costs run about eleven per cent ahead of last year. Credentialing leaders put it plainly, with fifty-six per cent describing themselves as understaffed while every position on the org chart carries a name. Hiring difficulty and five-year pay growth: [MGMA, 2026](https://www.globenewswire.com/news-release/2026/06/25/3317893/0/en/medical-practice-pay-cools-but-hiring-pressure-holds-firm-new-mgma-report-finds.html) ### Where artificial intelligence landed here Four in five health systems explore generative AI in the revenue cycle. Under two per cent have it integrated across the cycle, and fifty-nine per cent sit at the start of that road. Payers moved faster, so denials shifted toward medical necessity and documentation. Human review still touches ninety per cent of denials before resubmission. It changed who denies faster. A person still works the denial. [Guidehouse, 191 provider executives, 2025](https://guidehouse.com/-/media/new-library/industries/health/documents/2026/health-revenue-cycle-management-report2026327.pdf) ### Outsourcing is the ordinary answer now - **Sixty-seven per cent of provider executives work with a managed services organisation** - **Two thirds outsource accounts receivable follow-up and collections** - **Half outsource coding, and thirty-nine per cent outsource denial management** - **Philippine healthcare services employ 200,000 people and earn $4.5bn a year** [See how we staff healthcare](/solutions/#healthcare) ## Why offshore hiring is the practical answer here Four reasons a dedicated team in the Philippines fits this work, drawn from the same published sources as the figures above. - 01 ### The work is already outsourced, by almost everyone Sixty-seven per cent of provider executives work with a managed services organisation, two thirds outsource accounts receivable follow-up, half outsource coding and thirty-nine per cent outsource denial management. Offshore support in revenue cycle is the ordinary arrangement now, so the live question is who runs your team and how well they know your payers. - 02 ### Local pay keeps climbing while the queue keeps growing Medical receptionist pay rose twenty-two per cent in five years and operating costs run about eleven per cent ahead of last year, while fifty-six per cent of practices report harder hiring. A dedicated seat in the Philippines holds a trained biller at a cost you agree in advance and keep for the length of the engagement. - 03 ### The Philippines already runs this work at scale Philippine healthcare information management employs about 200,000 people and earns roughly 4.5 billion dollars a year, with coders who hold United States certifications and billers who read a remittance advice the day they start. - 04 ### Overnight is exactly when claims work best Claim submission, payment posting and accounts receivable follow-up run beautifully while your clinic sleeps, so the work is waiting for the front desk when the doors open rather than competing with patients for attention. ## How we staff it A dedicated team built around one operation, trained on your own steps, with one named account lead who answers for the result. - **Revenue cycle management**Charge entry, claim submission, payment posting, AR follow-up and patient balances. - **Medical billing and coding**CPT and ICD-10 coding, modifier accuracy, audits and rebill preparation. - **Provider credentialing**Payer enrolment, CAQH maintenance, revalidation calendars and roster upkeep. - **Prior authorization**Benefit verification, submission, payer follow-up and a status register your front desk can read. ### Malasakit runs this engagement Assess, design the solution, implement. Three stages, and the same idea underneath all three, because caring for your problem the way we care for our own is what makes the assessment honest and the design yours. [See how we work](/solutions/#method) [See the full Healthcare operations scope](/solutions/#healthcare) ## Read the other three [Technology support](/industries/technology/)[Marketing operations](/industries/marketing/)[Executive support](/industries/executive/) ## Tell us what the operation looks like A 60-minute discovery call maps the work, the volumes and the service levels, and you leave with a written scope that stays yours either way. [Book a discovery call](/contact/#book)[Back to Industries](/industries/)