Published in HFMA Colorado Chapter, Colorado Connection Weekly Newsletter June 2025 | Author: Jeffrey Gardner, Client Success Director, Aspirion
Hospitals across the nation are grappling with soaring denied claims, with payers rejecting $260 billion worth of inpatient claims annually. This growing issue, amplified by partial denials like DRG downgrades and length-of-stay disputes, demands substantial effort for minimal recovery. Compounding matters, payers have capitalized on advanced technology to streamline denials management, leaving providers behind on an uneven playing field.
Workforce shortages add to the strain, as the demand for skilled professionals such as nurses, coders, and attorneys outpaces supply. On average, highly trained appeal staff manage just 2.5 appeal letters a day, unable to keep up with escalating denial volumes under traditional methods.
This is where artificial intelligence (AI) steps in—not as a tech trend, but as a strategic solution to refine revenue cycle management. Effective AI implementation starts with reviewing existing workflows and incrementally introducing automation. Machine learning can prioritize high-impact claims, while AI efficiently processes medical records to surface evidence for appeals. This tactical use of technology enables healthcare organizations to recover dollars from previously uneconomical denials.
Real-world implementation presents challenges, such as cleaning up data, navigating payer policies, and managing change within teams. However, when done right, AI augments rather than replaces human expertise, empowering professionals to focus on more complex and meaningful tasks. Organizations also report marked improvements in efficiency and staff satisfaction.
The 2025 HFMA Annual panel offers insights from industry innovators like Banner Health and Houston Methodist, sharing strategies, hurdles, and outcomes of their AI-driven approaches. Attendees can gain actionable takeaways to bolster financial performance in an increasingly complex reimbursement environment.
With payers advancing their capabilities, the time to invest in AI and automation is now. The question isn’t whether to adopt these tools, but how to leverage them strategically to secure your organization’s financial future.
Read the full HFMA Colorado Connections Newsletter article here.