In one of our recent discussions, revenue cycle leaders from across the country came together to share best practices, current challenges, and forward-looking ideas around navigating ongoing disruption, from denials and payer behavior to the evolving role of AI and state-level regulation.
What surfaced was clear: No one has it fully figured out, but we’re all getting smarter by sharing openly.
Key Takeaways from the Conversation:
1. Denial Management Requires Coordination and Accountability
Whether through robust reporting dashboards, denial-specific project teams, or integrated revenue steering committees, organizations are getting more proactive in pinpointing root causes and driving upstream improvements. Several members emphasized the value of cross-functional partnerships with CDI, Managed Care, and Analytics to close gaps and prevent recurring write-offs.
2. The Payer Landscape Is More Fragmented Than Ever
Members shared frustrations with inconsistent payer behavior, growing administrative burdens, and tactics that appear to deliberately delay reimbursement. From revenue code mismatches to level-of-care downgrades, the consensus was clear: navigating these issues requires real-time data, strong internal communication, and creative escalation strategies.
3. AI Adoption Is Still Early and Still Risky
While interest in AI continues to rise, many expressed skepticism around vendors’ true capabilities. Several leaders noted that so-called AI often masks manual workflows behind the scenes or comes with steep implementation costs that don’t always deliver immediate ROI. That said, select early adopters are beginning to explore predictive denials, pre-claim reviews, and automation tools with cautious optimism.
4. State-Level Policy Changes Are Adding Complexity
Attendees flagged new and proposed state mandates (including those in Texas) as potential barriers to care access, especially for vulnerable populations. These changes are forcing hospitals to weigh compliance requirements against long-standing values around patient trust and timely treatment.
5. Peer Insights Matter
Throughout the conversation, members emphasized the need for reliable vendor references and shared evaluation tools. A few groups have begun exploring the idea of a community-built rating system to support vendor selection and performance tracking, something we’re continuing to explore together.
What Are You Seeing?
From payer challenges to AI pilots to new policy rollouts, we want to hear what’s happening in your world. Share your thoughts in the community or join us at an upcoming RCM Innovators session.
And if you haven’t already, be sure to mark your calendar for the next RCM Innovators Meeting on Friday, August 15 at 2:00 PM ET.
We’re grateful to all who joined this thoughtful and candid discussion. Let’s keep the momentum going.