From reactive denial management to upstream prevention
Denials are usually discovered after adjudication. The revenue loss, however, often begins much earlier. Hospitals continue to invest significant time and resources in denial management, yet roughly 15% of claims are initially denied. Hospitals spend nearly $19.7 billion each year appealing them and only about half of those denials are ultimately overturned. That raises a…
From back office to balance sheet: Why revenue cycle is becoming strategic AI infrastructure
Healthcare finance leaders are confronting a new reality: Revenue cycle performance now directly influences organizational stability, capital planning and access to care. Rising denial rates, expanding prior authorization requirements and persistent staffing constraints have transformed revenue operations from a transactional function into a strategic enterprise capability. Recent reporting from Kaufman Hall shows denials and revenue…
Report: Payer requests for information are slowing reimbursement
Payers are increasingly rejecting claims through requests for information (RFI) that in total serve no purpose other than to delay reimbursement, according to “Death by a thousand requests,” a report from consulting firm Kodiak Solutions. RFI claim denial rates as a percentage of total billed charges climbed to 3.82% in 2024 through May, up from…