As health systems work to shore up margins in 2026, revenue leakage has become one of the most direct operational targets. At UC San Diego Health in San Diego, Calif., Chief Revenue Cycle Officer Mike Vigo has built fiscal 2027 around the problem and said the challenge starts with accepting that no solution stays solved for long.
The work of capturing charges accurately, he said, is continuous by nature. Payer rule changes and government updates arrive regularly, and an area a team has addressed can reopen within a year or two.
“The opportunities for charge capture will change across even an area that you might be sustained in within a year or two,” Mr. Vigo said. “There’ll be an updated change that’ll come through that we have to respond and react to.”
For that reason, UC San Diego Health has built its response infrastructure proactively, testing changes with subject matter experts and information services teams, updating charge description master pricing and monitoring claims for both accuracy and timeliness.
Two areas in fiscal 2026 yielded meaningful recoveries. The first involved radiation oncology, where coding changes effective for calendar year 2026 required the team to identify updates early, realign pricing to match the revised codes and monitor claims for accuracy and timeliness. When historical accounts required attention, the team coordinated across revenue integrity, charge description master pricing, the clinical department and billing and collections to pursue reprocessing within applicable timely filing windows.
The second focus area was the emergency department. Health system finance leaders have flagged reimbursement pressure and payer friction as among the most acute threats to hospital margins heading into the second half of 2026, and ED triage leveling is one place where that pressure materializes in charge capture.
“When it comes to some of the way that we were monitoring the services we were providing and charging for the hourly care that was being provided [in the triage unit] — as you can imagine, the acuity coming in through various points within the emergency department, whether it’s burn or trauma, whatever that is — we had to make sure that we were respecting the acuity of the patients coming in, honoring the criteria and scoring [patients],” Mr. Vigo said.
The challenge extended beyond acuity assignment. Ensuring that the hospital-level charge accurately reflected facility resources while the professional fee reflected physician and provider effort required keeping two distinct billing streams aligned and compliant. At UC San Diego Health’s scale and complexity, that alignment is necessarily institution-specific.
“I’m blessed that we work at a large institution that pretty much checks every single specialty box out there. So it’s a very complex set of patients we’re seeing and it’s very rare that we can have a one size fits all solution,” Mr. Vigo said.
The revenue integrity and charge reconciliation teams have structured projects planned throughout fiscal 2027, organized around a disciplined approach to ensuring compliant charge capture while identifying applicable modifiers and coding opportunities. Mr. Vigo describes the work as cyclical by design, a process of continuous review rather than point-in-time auditing.
“The target’s always moving,” he said. “So what is the process? How are we relooking at that to make sure that we’re maximizing value there?”
