Payer denials have nearly doubled since 2020, and the organizations absorbing the damage are doing so quietly. For health system revenue cycle leaders, the question is no longer whether denials are a strategic threat but whether their organizations are responding with the same intentionality payers are using to issue them.
During a featured session at Becker’s 16th Annual Meeting in April, hosted by CorroHealth, two executives from the company unpacked why conventional denials management falls short and what a winning strategy actually requires. The speakers were:
- Tami Knobbe, executive vice president at CorroHealth
- Erica Strick, vice president of denials management services at CorroHealth
Below are four takeaways from their conversation.
1. Payer strategy
The first mindset shift Knobbe and Strick urged health system leaders to make is deceptively simple: stop asking what your organization did wrong when a claim is denied. Total Medicare Advantage denials climbed from 17.4% in 2020 to 32.0% in 2024, with major payers including Aetna, Humana, UnitedHealth and Blue Cross Blue Shield all trending in the same direction.
That pattern, Ms. Strick argued, is not a coincidence. Hospitals that treat denials as an isolated documentation error miss the broader picture, that the burden of proof has been deliberately transferred to providers and payers are counting on organizations to respond reactively rather than strategically.
2. A shifting threat
DRG downgrades remain significant, but Ms. Knobbe identified that 30-day readmission denials are up 134% year over year and no-authorization denials have climbed 50%. By comparison, DRG downgrade volume is up just 1%.
Organizations that built their denials strategy around denials categories are already at a disadvantage. “If you have built your strategy just on any one of those things, you’re already behind the game,” Ms. Knobbe said. The financial stakes are staggering, hospitals spent $43 billion in 2025 chasing payments insurers already owed, including $18 billion specifically overturning claim denials, with individual DRG downgrade cases costing between $3,000 and $7,000 each.
3. People and culture
The session’s central framework positioned people first, contracts second and technology third. Ms. Strick described the pattern at high-performing health systems as CDI, coding, denials, managed care and clinical leadership functioning as a single integrated team, not five siloed departments reacting to the same problem from opposite ends of the revenue cycle.
Denials committees, she noted, should include active clinicians and managed care representation, not just nominal participation.
On the contract side, Ms. Knobbe emphasized that organizations should review payer contracts for explicit DRG validation and medical necessity language, never sign a DRG audit letter without legal review and ensure timely filing windows are negotiated clearly. If contract language doesn’t define the criteria, she warned, payers will define it themselves.
4. Why technology works
CorroHealth’s own platform served as the session’s case study for what well-sequenced technology adoption can produce. Over an 11-month period in 2025, one client realized $11,168,813 in revenue lift across 28,658 reviewed cases, with an 86% query acceptance rate and a 97% physician response rate — a notable figure at a time when query fatigue is a widespread concern.
The takeaway for evaluating any technology vendor should prioritize confirming the technology surfaces what the human eye would miss, operates in the pre-bill space and generates a continuous feedback loop back to clinical and coding teams.
“The right technology makes your people more effective,” Ms. Knobbe said.
She closed with three actions that require no budget: audit the denials committee for genuine clinical engagement, pull the last 90 days of DRG downgrades and ask whether CDI is seeing the data and review the top three payer contracts for explicit DRG validation language.
For health systems looking to close the gap the battle is winnable, but only for organizations whose strategy is as intentional as the payer playbook.
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