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 financial stability.
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How to Protect Revenue
Protecting revenue begins with visibility into the entire revenue cycle, from front-end processes like registration and financial clearance to back-end functions such as coding and claim management. By continuously monitoring trends and analyzing denials, healthcare organizations can quickly identify whether revenue leakage is driven by payer behavior or internal process gaps.
This data-driven awareness allows teams to:
- Address root causes proactively
- Tighten workflows, and
- Improve overall revenue performance through improved financial interactions
Additionally, the adoption of ambient artificial intelligence (AI) documentation tools can reduce the cognitive burden on physicians and improve the accuracy of clinical documentation, ensuring that claims are processed correctly the first time.
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How to Close Gaps Across the Revenue Cycle
The revenue cycle functions as an interlinked system, where effective execution in the front and mid-cycles directly influences back-end outcomes. It's essential for finance, health information management (HIM), and clinical teams to establish processes to operate seamlessly across all aspects, from identifying missed revenue opportunities to optimizing workflows. Combining the expertise of skilled professionals with advanced technologies can help ensure that every dollar earned is successfully collected.
Key opportunities where healthcare leaders can close financial gaps and maintain efficiency include:
- Front end: Ensure eligibility, benefit accuracy, medical necessity documentation, and prior-authorization readiness are both payer- and plan-specific. Exceptions and delays often occur when intake processes rely on generic data or incomplete validation.
- Middle: Coding quality drives both days sales outstanding (DSO) and audit exposure. Pair coder expertise with natural language processing (NLP) assistance to maintain consistency and escalate only truly ambiguous cases. Autonomous NLP-powered coding tools can rapidly process extensive documentation, improving accuracy and reducing turnaround time.
- Back end: Intelligent work queues should be routed based on recoverability, not chronology. Appeals packages must automatically assemble the correct clinical artifacts and policy references on first submission to minimize rework and speed resolution.
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How to Accelerate Automation with Hybrid Intelligence
Intelligent automation, powered by hybrid intelligence that combines human expertise and AI, is helping healthcare organizations face increasing pressure to do more with fewer resources.
This accelerated automation can:
- Streamline workflows
- Reduce operating costs, and
- Enhance results while maintaining quality and compliance
Predictive modeling can flag high-risk claims before submission, allowing teams to intervene early and prevent denials. Automation, AI, and advanced analytics can eliminate repetitive, manual tasks that drain time and capital, freeing staff to focus on more strategic, judgment-based work.
By embracing technology, fostering collaboration, and making strategic investments, healthcare organizations can leverage opportunities for innovation and growth. Watch the full presentation, "Navigating the Unknown: Federal Policy Shifts and the Future of Healthcare Finance," to gain deeper insights into these revenue cycle management strategies and hear directly from industry experts.
Cheryl Cruver
