Ask a Revenue Cycle Leader is a new series featuring insights from health system and hospital revenue cycle executives nationwide. Becker’s poses questions on the most pressing issues in healthcare finance — from payer relations and automation to workforce and patient experience. We welcome responses from all revenue cycle, finance and reimbursement leaders.
Question: What is the most dangerous trend in the revenue cycle today, and why?
Jennifer Armendariz. Vice President of Revenue Cycle and Managed Care at Valley Children’s (Madera, Calif.): The most dangerous trend in revenue cycle is the increasing ability of payers to reduce reimbursement through policy changes rather than contract negotiations. Hospitals can negotiate rates, but they cannot realistically keep pace with hundreds of evolving payment edits, coverage restrictions, and billing requirements. The cumulative impact can silently erode reimbursement, increase administrative costs, and undermine the financial predictability that healthcare organizations rely on to serve their communities.
Salonia Brown. System Vice President of Mount Sinai Health System (New York City): The biggest danger isn’t any one thing specifically, it’s that the economics and operating model of RCM are changing faster than most organizations are redesigning themselves. Included in this is the payer-provider AI arms race, payers are getting more sophisticated at adjudication, edits, denials, authorizations, and payment integrity while providers are deploying AI to fight the resulting volume. Automating the fight instead of fixing the underlying economics just don’t work. I also see organizations sprinting to use AI prematurely and end up making bad processes faster. One additional [danger] that I see is RCM teams remaining reactive in an increasingly predictive world.
Mark Evard. Vice President of Revenue Cycle Operations at University of Texas Medical Branch (Gavelston): It is no longer business as usual and honestly hasn’t been for quite some time. As the use of AI grows, our teams will need an enhanced skill set which includes an enormous number of analytical skills in order to survive in the new world of revenue cycle operations.
MariaRita Genovese. Director of Revenue Cycle and Business Operations for MD Anderson Cancer Center at Cooper (Camden, N.J.): The most dangerous trend is prioritizing automation over expertise. AI and automation can improve efficiency, but when implemented without the right controls and knowledgeable oversight, they can amplify errors at scale. As revenue cycle organizations push for greater efficiency, there is a real risk of automating flawed workflows, coding decisions, authorization processes, and denial management. In complex revenue cycle areas for example, oncology, technology needs to support, not replace human judgment, clinical understanding, and accountability.
Paul LePage. Vice President of Revenue Cycle at UC Davis Health (Sacramento, Calif.): The most dangerous trend in revenue cycle today is the normalization of workarounds instead of fixing the root cause of revenue leakage. Organizations continue to add staff, vendors, technology, and work queues to manage denials and other problems rather than addressing why those problems are occurring in the first place. AI and automation can make this even more dangerous by allowing us to become incredibly efficient at processing bad processes. The best revenue cycle isn’t the one that works the most problems; it’s the one that creates the fewest problems to work.
Joe Palumbo. Executive Director of Front End Operations at WakeMed Health & Hospitals (Raleigh, N.C.): The ongoing battle to reduce prior authorization requirements continues to push healthcare providers down a reckless never-ending highway of obstacles. Many health plans continue to require PA for many imaging studies, specialty drugs, outpatient procedures, post-acute care services, and certain surgeries as continue to maintain that is necessary to control costs and prevent unnecessary care. One of the impediments to adding or expanding new service lines for a community hospital or health system continues to be the extensive requirements around prior authorization. More compounding is that denial rates for PA requests remain significant, for both Medicare Advantage and Medicaid managed care plans. The bright spot in the distance is CMS’ Interoperability and Prior Authorization Final Rule, which continues to increase regulatory pressure.
Drew von Eschenbach. Vice President of Enterprise Revenue Cycle at UW Medicine (Seattle): I think the most dangerous trend in healthcare revenue cycle is the perfect storm that is brewing with continued industry-wide denial pressure from payers who continue to deny claims at an unprecedented rate while the federal government continues to burden and restrict reimbursement to providers for providing exceptional care. Providers who are not equipped to address denials and support the rigors of the dispute resolution process will continue to lose out on much-needed reimbursement for services while HR1 stands to further restrict the revenue stream to support patient care. This is an unsustainable path to potentially compromising the health and well-being of our communities.
Erika Whitney. Vice President of Revenue Cycle at Prestige Healthcare (Louisville, Ky.): A trend that concerns me is the assumption that gains in efficiency automatically create extra capacity (or should). This is especially true today, where AI is being hyped as the solution for everything.
Every time a new tool allows providers to do more with less resources, the system finds a way to give them more to do — additional documentation, more complexity, new rounds of audits — all while reimbursement stagnates. Even though organizations become more efficient, they’re constantly being asked to take on more work for the same result.
Executives understandably want to see a reduction in expenses or an increase in revenue to justify investments in new technology. But in the hi-tech arms race between payers and providers, efficiency gains become the new baseline rather than a lasting advantage, and often the best an organization can do is to maintain the status quo.
Next question: How has your definition of revenue cycle success changed over the past several years? If you are interested in responding, please send responses to Andrew Cass at acass@beckershealthcare.com.
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.
