Healthcarercm

  Denial management and prevention  remains a critical area of focus in healthcare revenue cycle management (RCM) for healthcare organizations and payers alike. Denial management is expensive, and if it is not avoided initially, it involves costly rework. As technology advances and payer behaviors shift, healthcare organizations must adapt to new challenges to ensure efficient claims processing and revenue protection. The Rise of AI and Automation in Denial Management In addition to robotic process automation (RPA), a trend in denial management is the increasing use of artificial intelligence (AI). Payers have embraced these technologies to streamline claims adjudication, reduce human intervention, and handle larger claim volumes. Leveraging AI can help healthcare organizations automate denial remediation processes to save time and reduce costs. AI-powered tools can now identify missing information in patient accounting systems, such as authorization numbers, and automatically...

  As healthcare organizations face increasing operating costs, policy changes, and more aggressive payer tactics, leaders need strategies to ensure financial stability. AGS Health recently sponsored a presentation to provide insights impacting health systems and revenue cycle management (RCM). Madeline Cree of The Health Management Academy outlined how the One Big Beautiful Bill Act (OBBBA) reforms are impacting Medicaid and Medicare, as well as reshaping supplemental payment structures and Affordable Care Act (ACA) subsidy design. Emily Paxman of KLAS Research shared insights into how healthcare organizations are responding to uncertainty, including investing in technology, restructuring their workforce, and exploring value-based care strategies. Amid these ongoing policy shifts and insights, I also shared three key revenue cycle management strategies for healthcare organizations to thrive: Every dollar matters, especially when revenue leakage and underperformance threaten finan...