When denials climb, the instinct is to add people—more appeals writers, more clinicians, more coders. It’s a reasonable response to a rising workload. It’s also one that fails faster than most revenue cycle leaders expect. Denials aren’t just increasing—they’re getting more complex, and no team can staff its way to keep pace.
The evidence is hard to miss. According to Kodiak Solutions’ March 2026 revenue cycle analysis, across more than 2,300 hospitals, revenue leakage rose roughly 25% in 2025, to $48.4 billion. In one 2026 industry survey, 76% of revenue cycle leaders said they expect denial rates to keep increasing. And in a poll of RCM leaders, payer behaviors overtook internal issues like staffing as the top-cited threat to revenue growth. The problem is no longer just that you’re short-staffed. It’s that the work itself has changed.
Even the Biggest Teams Are Hitting the Wall
Consider Cleveland Clinic. Its revenue cycle team collected more than $15 billion in net patient revenue in 2025, employs more than 3,800 people, and overturned 92% of denials—and its leaders still describe the current model as unsustainable. “It’s not sustainable. And frankly, it’s arguably unsustainable for the payers, too,” the health system’s CFO told Becker’s, pointing to the enormous administrative effort required to move denials from a 15% incoming rate down to a controllable loss under 2%.
If one of the most resourced revenue cycles in the country can’t simply staff its way past denials, that should tell the rest of the industry something. This isn’t a gap you fill with headcount. The process is too labor-intensive for human resources alone to tackle.
The Math Doesn’t Work by Hand
There’s a structural reason manual appeals hit a ceiling. Clinical denials are the most complex category in the revenue cycle—each one can require reviewing hundreds or thousands of pages of medical records to build a defensible argument. That expertise is expensive and finite, which creates what revenue cycle leaders call the “long tail” problem: when the cost of manually working a denial approaches the dollars at stake, even legitimate, recoverable claims get written off simply because they aren’t worth the hours.
The economics compound the point. Revenue cycle operations already cost an at-scale health system 3% to 4% of revenue, while roughly 20% of claims are denied on average. Adding staff scales your capacity in a straight line. The denials volume—and the record-review burden behind each case—is climbing faster than that.
Augment Your Experts, Don’t Just Add More
The way forward isn’t asking your team to do more, or to learn a new tool—it’s offloading the manual, repetitive tasks to a service built to handle it, so the work moves off your team entirely rather than asking them to absorb it.
Effective AI-powered denials management pairs automation with expertise instead of choosing between them. AI does the heavy lifting that your team doesn’t have the bandwidth to tackle—ingesting the medical record, classifying the denial, and assembling an evidence-based argument grounded in the chart and the applicable clinical criteria, with every clinical statement traceable to its source. Clinical and legal specialists can verify and refine each appeal rather than building it from a blank page. It’s the principle the industry is converging on—keep a human in the loop and let the technology carry the volume.
This is the engine behind Aspirion’s AI-powered denials management services, which uses its proprietary DocIQ technology alongside its own clinical and legal experts. DocIQ builds the case for each individual appeal; a second, related platform, ClinIQ, looks across the full denial population to surface the patterns behind them (more on that below). The measurable effect of working this way can show up in the numbers: Aspirion’s own client data shows appeals filed 2.2 times faster, closures 1.4 times faster, and a 64% resolution rate on clinical denials. (For more on judging that kind of impact, see how to measure what matters.)
From Working Denials to Understanding Them
Headcount also can’t tell you why denials keep coming. Technology can. The same records that support an appeal hold a second layer of information: read across the entire denial population, they reveal whether a recurring denial reflects payer behavior or a documentation gap—two problems that call for vastly different responses.
Surfacing that distinction is what AI can do, giving CDI, UM, and managed care teams a clear view of where a recurring issue starts. This is where ClinIQ, Aspirion’s clinical denials intelligence platform, comes in. Instead of re-working the same denial one appeal at a time, ClinIQ turns denials data into clear clinical insight, showing exactly where documentation and evidence fall short. Aspirion’s Client Success partners bring those insights directly to their clients’ teams—along with specific ways to strengthen documentation and improve overturn rates going forward.
Denial volume isn’t going back down, and neither is its complexity. The health systems keeping pace aren’t the ones with the most staff, they’re the ones pairing their teams with technology built for the scale of the problem. Ready to see what’s possible for your organization? Let’s talk.
