HCA Healthcare CFO Mike Marks said payers have outpaced hospitals on AI-driven claims processing, adding another layer to the friction hospitals face on denials, underpayments and prior authorization.
“I know there’s a lot of talk about AI in the hospital revenue cycle, we’re behind the payers, in my view,” Mr. Marks said Sept. 15 at the Jefferies Healthcare Services and Technology Conference in Nashville, Tenn., where the 190-hospital system is also headquartered.
Payers, he said, have real incentives driving their AI investments, including medical loss ratios and patient populations to manage.
“They’ve been working really hard on their version of AI in their claims shop,” he said.
Mr. Marks said that while payer friction is not a new issue, “there has clearly been a growth in friction over the last several years.”
HCA began investing more heavily in its Parallon revenue cycle operation in late 2022, adding staff and technology focused primarily on denials and underpayments, according to Mr. Marks. He said he feels good about where HCA stands today in responding to that environment.
“The administrative cost that they have and that we have to administer all of these claims is enormous,” Mr. Marks said. “And so we do have the opportunity to help each other here.” He added: “I do feel like there’s a pathway to make it better over time.”
Mr. Marks also pointed to a nearly two-year-old effort with about five of HCA’s major payers to build digital data exchange partnerships aimed at cutting administrative friction on both sides.
“This claims environment needs reform between providers and payers,” Mr. Marks said, describing conversations with HCA’s major payers as “very productive.”
He said HCA is more than halfway through its 2027 payer contract renegotiations and is still securing rate updates largely in line with its targets despite the friction.
Looking ahead, Mr. Marks said HCA’s next phase of cost and efficiency work — what he called “financial resiliency 2.0” — will rely more heavily on AI and automation, along with expanded shared-service capabilities benchmarked against Fortune 100 companies.
