Hospitals spent an estimated $43 billion in 2025 chasing payments insurers already owed — and many of the most financially damaging losses, including DRG downgrades, never trigger a formal denial alert at all.
As payer tactics grow more automated and harder to detect, revenue cycle leaders are rethinking how they track, defend against and ultimately prevent revenue erosion.
During a recent webinar hosted by Becker’s Healthcare and CorroHealth, leaders from Prisma Health, The University of Kansas Health System, UC Davis Medical Center and Mount Sinai Health System shared candid lessons on what traditional denial tracking misses and where the real leverage lies.
Here are four key takeaways from the conversation:
1. Hiding in plain sight
Panelists agreed that the denials doing the most damage often aren’t denials at all. Tami Knobbe, executive vice president at CorroHealth, described the “hidden denials” her team sees across its client base — short payments, changed DRGs and altered length-of-stay approvals that never surface on an 835 remittance. Organizations that don’t aggregate that data find out months later, after the revenue is gone.
Anne Robertucci, vice president of clinical revenue cycle at Prisma Health, put the trajectory plainly, describing a denials landscape that is “like a huge waterfall that has tripled in size over the last several years.”
She pointed to a newer surprise in prepayment DRG downgrades, where payers deny before issuing any payment. In many cases, she noted, “they’re just denying to deny.”
2. Why collaboration matters
A recurring theme was that fragmented CDI, coding and denials teams hand payers an opening. Richard Nagengast, vice president of professional billing revenue cycle at Mount Sinai Health System, described a system-level transformation that placed all revenue cycle functions under a single chief revenue officer.
“It’s a true revenue cycle where everybody from CDI to registration to the GDP shop now understands we all have skin in the game to the point where our basic goals are shared across the entire health system,” said Mr. Nagengast. “We all have increased accountability and visibility now because we don’t have that fragmentation.”
Rebekah May, CDI director at The University of Kansas Health System, offered a concrete example. By bringing clinical partners to the table on sepsis, the system’s biggest source of DRG downgrades, her team exposed documentation gaps around linking sepsis to organ dysfunction and pushed back on payers using shifting SEP-2 versus SEP-3 criteria to justify downgrades.
3. Prevention starts upstream
Several panelists stressed moving the work earlier in the revenue cycle. Penny Jefferson, director of clinical documentation integrity services at UC Davis Medical Center, is focused on documentation that supports inpatient level of care — ensuring physician advisors document admissions appropriately so cases are defensible before a denial ever arrives.
“We can look at dashboards all we want all day long, but until we take action and move our processes and start implementing change where we can now, we’re just going to continue the cycle,” said. Ms. Jefferson.
That upstream lens also shaped the group’s view of AI. Ms. Knobbe pointed to ambient listening and automation of repetitive tasks as game changers, paired with a “fast fail” discipline. But Jefferson cautioned that physicians own everything they sign — AI-surfaced documentation must be validated, not trusted blindly. Ms. May echoed the point, describing how her CDI team is empowered to “stop the line” when a note looks AI-generated rather than physician-authored.
4. An underused defense
Looking ahead, panelists identified contracts as the most overlooked leverage point. Ms. Robertucci noted that hospitals are held to strict response timelines while payers face little reciprocal accountability.
Mr. Nagengast agreed the opportunity is “prodigious,” arguing the conversation has moved beyond rates: his team is building a bank of best-in-class contract terms and measuring the cost of the appeal process itself, which quietly erodes hard-won rate increases. As he summed it up, denials data is “your way into the negotiating table.”
Across every topic, the panel agreed that defending revenue now requires breaking down silos, building a clinical voice into both AI governance and contract negotiations and shifting from reacting to denials toward preventing them by design.
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.