AI Adoption in denials management lags as other RCM uses expand
Denials management, one of the toughest tasks in hospital revenue cycle management (RCM), deserves more attention from AI experts, but RCM execs are not diving in with AI solutions for multiple reasons. About one in five healthcare providers apply AI to denials management, a 2025 Bain & Co. survey found. Instead, providers have turned more…
Battle of the Bots intensifies over denials
Healthcare payer claim denials are getting smaller, sneakier and faster. The battle of the bots over healthcare claims payment delivered record blows in 2025, with initial denials sometimes occurring within seconds of submission.a “Payers are becoming more sophisticated in their use of AI, and the denials are coming faster than we can keep up,” said…
How enhanced medical documentation can combat rising payer denials
Hospital executives across the country are increasingly frustrated with rising denial rates from payers. At a recent HFMA conference, revenue cycle leaders voiced concerns about what they perceive to be bad-faith payer denial practices. Although such frustrations have some validity, hospital leaders will accomplish little if they focus solely on payer behavior. Instead, they should…
Get paid what you’re owed: Smarter contracting, internal alignment can reduce denials
Hospitals and health systems are grappling with rising denial rates, particularly among commercial and Medicare Advantage plans. Years ago, denials might have been isolated friction points in the billing process; but as rates have risen, denials have become a strategic-level issue with a measurable impact on financial performance. Historically, denial mitigation efforts tended to focus on…
Navigating the rising tide of denials
Managing the healthcare revenue cycle is more challenging — and more critical — than ever. Amid sluggish margins, ongoing staffing challenges and rising costs, providers feel unprecedented pressure to optimize their revenue cycles. Addressing the ever-increasing issue of denials is a great place to begin. The latest data on denials and proven strategies to reduce…
Congressional hearings on the Change Healthcare cyberattack bring attention to providers’ continuing predicament
Two congressional hearings involving the CEO of UnitedHealth Group offered few concrete solutions to the issues surrounding the Change Healthcare cyberattack but did highlight the ongoing pressures facing healthcare stakeholders. Andrew Witty, the CEO, was questioned May 1 by the Senate Finance Committee in the morning and a House subcommittee in the afternoon. For providers…
Battle of the bots: As payers use AI to drive denials higher, providers fight back
Two fighters face each other in the ring, circling together, assuming there will be a single victor. One, representing the U.S. health insurance industry, has made huge investments in aggressive technology over the past several years to automate claim processing and reviews, making it hard for the other fighter — representing the nation’s healthcare providers…
While increasing revenue is a top goal for 2024, improving the patient experience is a close second — specially for large health systems: HFMA poll
In a recently conducted survey, 70% of 92 respondents said increasing revenue is a top priority in 2024 followed by improving the patient experience (60%) and reducing costs (55%). Review other key findings in this research report.
How healthcare finance organizations are working to become more resilient
Seven healthcare financial executives share their strategies for tackling the challenges of financial management in the current environment in this roundtable.
Medicare beneficiaries would have new options for appealing their hospital patient status under a proposed rule from CMS
A proposed rule from CMS would affect the appeals process for some patients whose status is reclassified from inpatient to outpatient observation during a hospital stay. After a 2020 court ruling that was upheld at the appellate level in 2022, the U.S. Department of Health and Human Services and CMS were obligated to create additional…