With AI-driven claim denials skyrocketing and a shortage of qualified revenue cycle employees available to tackle the resulting workload, hospitals and health systems are failing to collect the revenue they’re owed at an alarming rate.

“The advance of technology is based on making it fit in so that you don’t really even notice it, so it’s part of everyday life.” – Bill Gates

The introduction of artificial intelligence and automation has been nothing short of transformative for healthcare RCM. After only a few years on the scene, it’s difficult to find an area of our industry that hasn’t been impacted by AI, from coding and billing to streamlining patient payments.

As we approach the halfway mark of 2024, healthcare costs in the United States continue to reach unprecedented heights. In 2023, expenditures were expected to reach up to $4.7 trillion. In 2031, that number is projected to be $7.2 trillion. (1) These dollar amounts underscore how critical it is for hospitals, health systems, and private practices to have the right revenue cycle infrastructure in place. Without one, collecting the funds required to expand services and meet the changing needs of patients is virtually impossible. 

Insurance denial rates have increased 20% in the last five years, according to a report by Healthcare Finance News. These rising denial rates are negatively impacting reimbursements and causing huge administrative burdens for hospitals, health systems and physician groups.

Managing denied claims has long put a financial strain on hospitals and health systems. In the past few years, the problem has only worsened as payers use AI to help delay payments and turn the claims process into a labyrinth for hospitals to navigate.

An astonishing 84% of health systems cite lower reimbursement from payers as a top cause of low operational margins, according to a report published by the Healthcare Financial Management Association (HFMA) and Eliciting Insights, a healthcare strategy and market research company.

This is a critical year for healthcare providers and their revenue cycle health. Though hospital margins are on the rebound, staffing shortages and rising labor costs persist, while claim denials continue to increase at a double-digit pace. Escalating healthcare costs are fueling a need to improve the patient experience in order to drive collections.

Do you feel like your healthcare enterprise is playing a board game and rolling the dice when it comes to managing claim denials? You are not alone. The follow-up process has certainly changed and become a huge burden for providers.

2023 was an important transitional year for healthcare. The COVID-19 federal health emergency has ended, and along with it, government programs such as the Coronavirus Aid, Relief and Economic Security (CARES) Act, that helped mitigate the economic burden on hospitals and providers.