Preventing denials before they happen: How revenue intelligence is reshaping the revenue cycle
Health systems continue to invest heavily in denial management. Yet denial volumes remain stubbornly high. The reason is simple: Most organizations are still focused on addressing denials after they occur rather than preventing them in the first place. Roughly 15% of claims are initially denied, and hospitals spent nearly $19.7 billion in 2022 appealing denied…
Patient POS collections pose a growing problem for RCM departments
Hospitals are collecting more of the amount owed by patients at the point of service (POS), but that effort is failing to put a dent in the overall collection rates by hospitals, according to a new report from Kodiak Solutions. The report notes that healthcare providers are getting better at collecting from patients, but the…
Peer Insights Playbook: The People Side of Autonomous Coding
Learn how organizations expanded career opportunities, redesigned auditing processes, and gained buy-in from coders, executives, providers, and vendors to successfully adopt autonomous coding technology.
Prevent denials by catching credentialing issues
Verifying the credentials of ordering physicians should be an essential part of revenue cycle management, and it could prove to be a fruitful endeavor. Ximena Restrepo, compliance and privacy partner for Billings Clinic–Logan Health, which serves residents of Montana and Wyoming, said Billings-Logan has saved thousands of dollars in avoided claim denials or in avoided…
Prior authorization is draining revenue, which is why automation has become a strategic imperative
Prior authorizations have entered a different era. The process has become one of healthcare’s most expensive administrative bottlenecks, affecting far more than physician practices. Across hospitals and health systems, it slows patient access, adds labor-intensive work, increases denial risk, and puts pressure on reimbursement and cash flow. For organizations focused on growth, margin, and operational…
Focus on patient care and access transcends hospital-centric model
Healthcare is shifting from a hospital-centric model to a more distributed, digital and patient-focused system, requiring revenue cycle management to evolve into a strategic enterprise capability. By leveraging AI, automation and revenue cycle data, health systems can reduce barriers to care, improve patient outcomes and strengthen financial resilience amid growing operational and reimbursement pressures.
A New Approach to Drive Best in Class Revenue Cycle Performance
Download this white paper to learn how adopting administrative autonomy, shifting from reactive denial recovery to proactive, AI-enabled prevention, reframes revenue cycle management as an enterprise operating model issue, enabling faster cash flow, reduced denials, and sustainable financial performance.
How to handle the revenue cycle skills gap
Revenue cycle management is becoming less about managing transactions and more about technology, as hospital finance departments shift toward AI-enabled workflows. Increasingly, skills valued by hospital and health system employers are aligning around automation and analytics. As Heather Dunn, chief revenue officer at Novant Health, said in “The Revenue Cycle of the Future,” a recently…
Stop Paying to Get Paid: New Research Reveals the Hidden Cost of Virtual Card Fees in Healthcare
New research reveals that virtual credit cards (VCCs) are costing healthcare providers millions annually through hidden fees and added administrative burden. Download this white paper to discover strategies that reduce payment costs, improve cash flow visibility, and strengthen revenue cycle performance.
The Hidden Cost of Payer Policy Changes: How Operational Lag Drives Revenue Leakage
Payer policy changes often outpace providers’ ability to update workflows, creating “Policy Drift,” which is an operational lag that leads to denials, underpayments, and administrative inefficiencies frequently misattributed to clinical errors. Download this white paper to identify, measure, and reduce Policy Drift, helping organizations cut revenue leakage and improve operational performance.