A recent capacity-filled panel session hosted by Aspirion at the 2025 HFMA Annual Conference in Denver, Colorado, explored how some forward-thinking hospitals and health systems are leveraging AI and automation to address challenges in the revenue cycle. The session brought together experts from leading healthcare organizations who participated in a pilot AI program to share their real-world aha! moments and experiences.
The panel session, “AI Revolution in Clinical Denials Management: Provider Insights from Groundbreaking Pilot Program,” included Katie LeBlanc, Chief Revenue Cycle Officer at Banner Health; Lisa Schillaci, Vice President of Revenue Cycle at Houston Methodist; Terrie Handy, Vice President, Chief Revenue Cycle Officer at Legacy Health.
Key Insights from Expert Panel Discussion
The expert panelists drew from their direct operational experience to provide insightful commentary on pressing industry challenges. The following captures the important questions and viewpoints explored during the discussion:
1. What trends are you seeing in clinical denials in terms of volume, growth, and behavior?
The healthcare leaders reported three alarming trends overwhelming traditional appeals processes: indiscriminate medical records requests based solely on dollar amounts, unmanageable DRG downgrade surges forcing dedicated subcommittees, and accelerating concurrent denials happening in real-time during patient stays.
The unanimous message: AI-powered payer systems are outpacing healthcare providers’ ability to manage appeals using traditional methods.
2. How are you adapting to clinical denials trends?
Panelists said they are implementing comprehensive organizational changes including prevention-focused team restructuring, centralization initiatives across multi-hospital systems, data-driven innovation teams transforming EHR data into actionable insights, and strategic technology adoption with “fail fast and learn” mentalities.
The common thread: shifting from reactive denials management to proactive prevention through structural reorganization and strategic technology adoption.
3. What resources do you need to manage clinical denials effectively?
RCM leaders face critical staffing challenges requiring strategic choices between expensive in-house expertise and external partnerships. Schillaci outsources appeal letter writing questioning whether specialized labor pools exist in competitive markets. Handy conducts time studies facing internal pressure from clinical staff who can’t keep up with volume. LeBlanc expanded teams but acknowledges labor scarcity will worsen. All view AI pilots as essential for efficiency gains.
4. How do you prioritize which denial areas and automation projects to tackle?
The RCM experts said they apply specific criteria emphasizing trust, existing relationships, and proven processes. Schillaci tests AI with existing vendors on areas where she had no current solution. Handy focuses on high-impact areas after learning from setbacks, reporting 50% success rates and $300,000 recovered. LeBlanc prioritizes vendors with existing data access to avoid contracting delays, automating known processes they lack capacity for.
5. What’s your risk tolerance for building AI solutions internally?
The panelists expressed cautious approaches balancing innovation with operational constraints. Schillaci characterizes Houston Methodist as “very conservative,” preferring to buy proven solutions. Handy forms AI governance committees while emphasizing revenue cycle can’t be slowed down. LeBlanc describes “spirited debate” but highlights the reality that building requires taking “A players out of operations for five months.”
6. What results and observations are you seeing from implementing AI?
The healthcare leaders reported significant improvements in success rates and operational efficiency. LeBlanc achieved 32% success rates on diagnosis-related group (DRG) downgrades—representing a 50% improvement over traditional methods. The most significant breakthrough: processing time reduction, enabling 20% more daily appeals. AI addresses the “long tail” problem by maintaining quality while reducing processing time from 40 days to single digits, explained panel host Jim Bohnsack, Chief Strategy and Client Officer from Aspirion.
7. What AI opportunities do you see emerging?
The panelists envision AI’s transformative potential while emphasizing strategic focus and partnership. Schillaci stressed creating clearer denial strategies to avoid “throwing wet blankets” on team passion. Handy emphasized navigating regulatory challenges while questioning why electronic systems haven’t delivered promised speed improvements. LeBlanc articulated Banner’s mission of “making healthcare easier” through AI reducing administrative burden and enabling human-centered care.
The insights from these RCM experts paint a clear picture: the denials management landscape has fundamentally shifted, with AI-powered payer systems creating unprecedented challenges that traditional approaches cannot address.
However, through strategic AI implementation, careful vendor partnerships, and organizational restructuring, these pioneering health systems are not only keeping pace but achieving remarkable results—some are already seeing a 50% improvement in success rates, as well as appeals being processed 20 times faster. Their collective experience demonstrates that while the transition requires thoughtful planning and resource allocation, AI-powered denials management represents the path forward for sustainable revenue cycle operations in an increasingly automated healthcare payment environment.
To watch the full on-demand HFMA Annual Conference panel session—as well as bite-sized video clips—click here.
At Aspirion, we invest in advanced technologies, so you don’t have to. Let our AI-powered revenue cycle management services boost your revenue recovery outcomes in the shortest time possible. Contact us today!
