Points of view

From connection to execution.

Open@Epic 2026 brought developers and healthcare leaders together around connectivity and implementation. What stood out to me from the conference was how quickly a strong connection can lose value in a real revenue cycle workflow. Across sessions and conversations, people returned to the same challenge: moving data is only the start. Financial value appears when a connection advances an account, reduces manual work, or exposes reimbursement risk earlier.

I left with five takeaways for revenue cycle leaders: standards enable connectivity, workflow ownership creates value, and governance supports scale.

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1. Connections must survive real work. | Connections Must Survive Real Work

‍A recurring theme at Open@Epic was the importance of moving beyond successful integration to reliable, repeatable execution. Once an integration goes live, it needs to handle the demands of daily operations, including high transaction volumes, incomplete information, and unexpected exceptions. Any disruption can affect revenue cycle performance, making reliability a financial priority as much as a technical one.

For revenue cycle leaders, this distinction has financial implications. An integration that works inconsistently can still create manual workarounds, delay authorizations, or leave accounts waiting for information needed to move forward. Testing before launch and monitoring after go-live mean less troubleshooting and more time improving workflows. 

2. APIs need someone accountable. | APIs Need Someone Accountable

Application programming interfaces (APIs) need an operational owner. Each use case needs a defined trigger, exception path, documentation standard, and accountable team.

The opportunity for health system CFOs and RCOs is to connect API performance to workflow outcomes. Tracking whether accounts advance, exceptions are resolved, and manual follow-up decreases provides a more meaningful picture than transaction volume alone. 

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From API response to revenue cycle results

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3. Agents must earn their keep. | Agents Must Earn Their Keep

Agentic AI generated plenty of interest, but the more useful question is where it adds value. Agentic automation fits best where volume is high, rules are defensible, and exceptions are bounded. Eligibility verification fits the bill well: automation handles repeatable checks while practitioners resolve ambiguous coverage or payer responses. Coding, payer-policy research, and A/R follow-up offer similar potential. 

A useful way to evaluate an agent is to follow one account from start to finish. Did the system retrieve the correct information, make an approved recommendation, and hand off a genuine exception to the right person? 

A faster automated step is helpful. A resolved account, with less rework and a clear audit trail, is a business result.

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4. Governance starts before launch. | Governance Starts Before Launch

Governance belongs in the original design. Conversations about autonomous workflows at the conference raised a familiar risk: capability can expand faster than accountability. Human validation, role-based permissions, auditability, security controls, and escalation thresholds need to be defined before launch. Retrofitting them after a workflow has started changing accounts is an expensive way to discover who owns the decision.

Revenue cycle AI governance needs to establish who authorizes an action, which evidence the system uses, which changes require review, and how drift is detected. These controls are especially important for coding, authorization, payer-policy interpretation, and claim changes. 

5. Better data, sharper decisions. | Better Data, Sharper Decisions

Better data exchange should sharpen decisions, not simply add another source of information. Combining claim, remittance, contract, and payer-policy data can expose where expected reimbursement diverges from payment. A useful signal identifies which variance deserves attention, who owns it, and how long the organization has to act. 

Comparing payer performance across sites can reveal recurring underpayments or claims stuck at the same handoff. Route those issues before they age into unpaid balances, then use the pattern to prevent recurrence.

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Production value is the test. | Production Value Is the Test

The conversations at Open@Epic reinforced something all technology leaders need to keep front and center: the best innovations make complex work simpler for the people relying on them. This means choosing where technology can make the greatest difference, building accountability into the workflow, and measuring success by what improves for the organization.

For revenue cycle leaders, the test comes after implementation. Are accounts moving forward with fewer manual interventions? Are exceptions being resolved before they delay reimbursement? Are teams gaining capacity without sacrificing accuracy? These outcomes tell us far more about the value of an investment than the number of integrations completed or tasks automated.

A successful demo gets people excited. Seeing technology perform reliably in daily operations is what builds confidence and justifies continued investment. The real achievement is turning technical progress into financial performance that lasts.

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Key Takeaways

• Interoperability creates value when a live workflow reaches a measurable financial outcome.
• API success depends on ownership of routing, exceptions, documentation, and the next account state.
• Agentic workflows need a unit-level business case tied to resolved work, accuracy, and cash impact.
• Governance designed before launch protects auditability, scalability, and reimbursement integrity.
• Technology and finance leaders need shared measures that connect system events to revenue cycle results.

Fast money has fine print. | Faster Payments Could Weaken Cash

A 30-day payment requirement sounds like a cash-flow win for health systems. The catch is the price. 

The new Lower Premiums, Faster Payments Act proposes replacing federal Independent Dispute Resolution (IDR) with a payer-set Qualifying Payment Amount (QPA) as the final out-of-network rate. Cash will arrive sooner, but at a lower rate and with limited ability to challenge how it was calculated. If passed, a payer’s formula will set the value of every protected out-of-network claim.

Arbitration gives providers a way to contest a payer's number. Without it, the fight shifts to contract strategy and claim accuracy. Health systems that measure speed and value together can catch payer errors early, no matter what Congress decides.

Here’s what CFOs need to know about the Lower Premiums, Faster Payments Act.

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Background: what changes when the QPA becomes the final payment. | What the Proposal Changes

Under current law, both providers and payers can move an eligible No Surprises Act payment dispute from open negotiation into federal IDR. The proposed legislation removes this pathway for most covered services after the proposed effective date, making the recalculated QPA the final out-of-network payment rate. 

The QPA is the median rate a health plan has contracted with providers for the same or similar service in a geographic area. The bill changes how that benchmark is set for 2028. It starts from eligible rates as of January 31, 2019, applies adjustments for incentive and retroactive payments, and then increases the result using the Consumer Price Index. Because payers calculate the QPA, the bill adds federal rule updates, annual audits, and public reporting to check their work. 
 

Four ways a faster payment can land. | Four Payment Outcomes

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CFO action: run the numbers before the payer does. | Quantify Exposure Now

Whether the Lower Premiums, Faster Payments Act passes is out of your hands. Knowing what your out-of-network claims are worth is entirely in them. 

Build a claim-level model instead of relying on a systemwide estimate. Segment covered out-of-network claims by payer, specialty, legal entity, and service type. Compare realized collections with a modeled QPA, then combine the yield difference with changes in payment timing, dispute fees, and labor. This reveals whether faster cash improves working capital or simply brings a smaller payment sooner.

The executive view should answer five questions:

1. How much revenue currently depends on IDR outcomes?
2. Where is the largest gap between modeled QPA and realized payment?
3. Can the organization prove bill transmission and identify late payment quickly?
4. What payment variance remains recoverable?
5. How could the change affect cost-to-collect, A/R days, and operating margin?

Start with existing A/R recovery and denial management data to set the baseline. The answers will reveal the largest gaps and who should own them.

CFO action: set one owner, one source of truth, and one escalation trigger. | Assign Ownership and Controls

Name one owner for QPA methodology, payer variance, and transition decisions, then give that person authority across contracting, treasury, billing, and revenue integrity. Measure the role on net yield against the modeled QPA instead of days to payment alone, so speed doesn’t hide a weaker yield. Two controls make the role work: a single source for expected QPA, and a documented payment-clock trigger with escalation thresholds for late or underpaid claims.

CFO action: separate pre-2028 claims from claims paid under the new benchmark. | Manage Two Claim Portfolios

If the bill advances, health systems will manage two populations at once: pre-2028 claims that remain eligible for IDR and later claims paid under the new benchmark. Combining them in one queue will distort aging, productivity, and recovery reporting. Keep pre-2028 and later claims in separate queues, so leaders can see whether legacy cleanup or the new benchmark is driving results.

How Vee Healthtek keeps you ready, bill or no bill. | Build Readiness Before 2028

CFOs do not need to predict the bill’s final form to prepare. They need a defensible exposure model, clear QPA ownership, and workflows that prove when payment is late or wrong. Even if the bill doesn't pass, the same model still exposes underpayments in today's out-of-network claims.

Vee Healthtek traces covered out-of-network claims from source data through payment to identify where time or value gets lost. Practitioner-led analysis connects claim classification, payer response, posting, and variance resolution, then converts recurring defects into workflow changes that prevent avoidable rework and improve reimbursement predictability.

Open Accountability keeps ownership and results visible. Leaders can see whether each intervention improves payment timing, reduces incorrect adjustments, and strengthens recovery instead of measuring completed activity. This creates a practical readiness plan CFOs can use, even if the bill never becomes law.

Key takeaways

• The final payment moves from an arbitration award to a payer-calculated benchmark, which closes off any chance to collect above it.
• A 30-day clock can speed cash, but the benchmark can lower the amount, so speed and value belong in one measure.
• A claim-level model by payer and specialty exposes gaps that systemwide averages hide.
• One owner for QPA accuracy and the payment clock makes late and incorrect payments visible and actionable.
• Tracking pre-2028 and later claims separately keeps legacy cleanup from masking how the new benchmark performs.

Top 5 HealthLeaders Exchange topics shaping revenue cycle.

At the October HealthLeaders CEO + CFO Exchange, health system executives kept coming back to the same challenge: there are plenty of worthwhile priorities, but only so much capacity to execute them well.

When every investment has a strong case behind it, the harder decision is where to focus and what to put on hold.

Revenue cycle tends to make the financial impact of these choices easy to see. Priorities that are poorly sequenced or under-resourced slow billing, increase rework, and delay reimbursement, while strong execution results in improved First-Pass Performance and more predictable financial performance.

Here are the top five takeaways from the event on where execution makes or breaks those results:

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1. Strategic priorities have to survive the execution test. | Execution Determines Value

‍A projected return is only as strong as the plan for delivering it.

Before saying yes to a new initiative, CEOs and CFOs should know what it will ask of teams, who can fix the underlying workflow, and whether the rollout will disrupt the work that keeps cash moving.

Take a new prior authorization tool, for example. Spotting payer requirements faster doesn't strengthen reimbursement if missing documentation and unresolved exceptions still land back in manual queues. A tool that finds problems but fixes none is just a messenger. An executable plan ties prior authorization to scheduling, documentation readiness, escalation ownership, and denial feedback, so the investment prevents authorization delays instead of reporting them.

Executives at the Exchange shared four conditions that separate an executable revenue cycle investment from another layer of work:

• The financial outcome is clearly defined in cash, reimbursement, margin, or cost-to-collect.
• The workflow owner can change the process where defects begin.
• Every team the workflow touches has agreed to the handoffs the change affects.
• Governance can prove the change removes rework after launch.

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2. Portfolio discipline protects workforce capacity and cash. | Priorities Protect Capacity

No one votes for an overloaded portfolio. It happens one reasonable yes at a time. 

Countless leaders at the Exchange described teams carrying more active work than they could execute. The same revenue cycle leaders, analysts, and IT resources support every initiative, so each new project slows the rest and pushes the return later than the business case promised.

A portfolio review makes that overlap visible. It lines up each initiative's expected cash and margin improvement against the demand it places on shared teams, workflow dependencies, and time to value. The result shows where capacity is already spoken for and which initiatives return the most for the capacity they use.

Capacity is the one budget line nobody can approve into existence. A good idea that starts a little later, with a team ready to carry it, can still deliver sooner than one launched into a team with no room.

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3. Revenue cycle investments are often fully funded but partially staffed. | Workforce Capacity Protects Cash

Approving the investment is the easy part. Finding the capacity to carry it through is harder. 

Executives at the Exchange were clear about the pressure on operational teams: constant reprioritization is driving burnout and leaving less capacity for new initiatives. The same teams keeping cash moving are often asked to learn new workflows, support the rollout, and handle whatever the technology cannot resolve.

The pressure adds up. When teams have to balance daily operations with implementation work, burnout rises, queues grow, and the expected return takes longer to show up. The investment can still succeed, but the organization pays more for the transition than leaders anticipated.

A stronger revenue cycle operating model plans for the workload created by the change. Deeper specialist coverage gives key employees room to focus and keeps work moving when volumes rise, payer requirements shift, or experienced team members are unavailable.

The takeaway for CEOs and CFOs is simple: funding the technology is only part of the investment. The larger decision is whether the organization has enough capacity to protect current performance while building what comes next. Funding the people and operating model behind the change reduces burnout, preserves cash during the transition, and creates the execution capacity needed to support future growth.

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4. AI should create value, not another queue. | AI Must Move Work

Artificial Intelligence (AI) creates financial value when it improves the economics of getting paid. Leaders should see faster claim readiness, fewer preventable denials, lower cost-to-collect, or more productive use of skilled teams. If AI identifies more issues but leaves the same manual work behind, it has improved visibility without improving financial performance.

CFOs can compare time to bill, denial rates, exception aging, manual touch volume, and labor cost before and after implementation. The value comes from strengthening the full path to payment, rather than optimizing one step while leaving the underlying cost elsewhere.

Faster detection only strengthens the return when it leads to quicker resolution, fewer downstream touches, and lower labor expense.

A practical revenue cycle AI review starts with First-Pass Performance. Measure whether more work is completed correctly before an edit, denial, appeal, rebill, or follow-up becomes necessary. The strategic objective is to turn AI into operating leverage, allowing the organization to handle greater revenue cycle complexity without adding cost.

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5. The 2030 portfolio can’t fund yesterday’s priorities. | 2030 Readiness Starts Now

‍Health system leaders can’t fund tomorrow’s priorities without making difficult decisions about today’s investments. 

A current investment shouldn’t be protected simply because it still performs its original function. CEOs and CFOs need to determine whether it improves financial performance across the enterprise. Leaders at the Exchange noted that the strongest investments connect enterprise revenue cycle data to action, reduce variation across facilities, and make reimbursement more predictable.

A 2030-ready portfolio requires executives to make two decisions with equal discipline: what to fund and what to stop funding. Continuing to protect investments that no longer strengthen cash flow, margin, or scalability limits the organization’s ability to execute higher-value priorities. 

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How Vee Healthtek turns priorities into executable results. | Vee Healthtek Supports Execution

‍Every priority competes for the same teams, so we start by showing which ones earn that capacity. We follow financial risk through the workflow to find where execution breaks down and rework begins. Practitioner-led analysis connects payer behavior with patient access, documentation, coding, claims, and A/R, so workflow changes target recurring causes. AI-enabled prioritization directs repeatable work to automation and complex exceptions to experienced teams, protecting reimbursement while preserving internal control.

A strong strategy begins with the workflow and ends with the financial result. Leaders who test investments for executability, remove lower-value initiatives, and measure First-Pass Performance will be most likely to protect current cash while building capabilities for the future. 

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Key Takeaways: | Key Takeaways

• Investment value depends on whether teams can execute change without weakening current cash performance.
• Portfolio review needs an explicit stop decision so lower-value work does not consume scarce capacity.
• Workforce capacity protects implementation quality and continuity across patient-to-payment workflows.
• AI earns its place when it moves risk to resolution and reduces rework, denials, or A/R aging.
• A 2030-ready portfolio connects enterprise priorities to first-pass yield and realized reimbursement.

The right revenue cycle partner protects the patient financial journey. | Start With Affordability

Healthcare providers should evaluate a revenue cycle management partner by asking a patient-centered question: Can this organization prevent avoidable financial harm while improving operational and financial performance? The answer requires more than promises about collections, automation, or staffing. A qualified partner should demonstrate how it establishes accurate coverage, estimates responsibility, prevents billing defects, connects patients with assistance, and resolves exceptions before uncertainty becomes a corrected statement or unaffordable balance.

The stakes are significant. A 2024 KFF analysis estimated that Americans owe at least $220 billion in medical debt; approximately 14 million adults owe more than $1,000. Meanwhile, a 2024 American Hospital Association report found that administrative costs represented more than 40% of hospital expenses, while commercial and Medicare Advantage care denials rose 20.2% and 55.7%, respectively, between 2022 and 2023. Partner selection therefore affects both institutional resilience and the patient experience.

Ten evaluation criteria reveal whether an RCM partner is patient-centered. | Evaluate Ten Capabilities

1. Coverage accuracy should come before collections. Patient access management, eligibility and benefits verification and insurance discovery should prevent avoidable self-pay classification and responsibility errors. Ask for eligibility accuracy, coverage-found rates, and related denials.

2. Authorization should protect access to care. Prior authorization workflows should identify requirements early, track payer decisions, escalate delays, and measure authorization-related denials and rescheduling.

3. Estimates should be explainable and reliable. Price transparency and patient estimates should combine known services, contracted rates, current benefits, and documented assumptions. Require estimate accuracy and variance reporting.

4. Affordability pathways should be built into clearance. Financial clearance and counseling should connect eligible patients with assistance, Medicaid screening, charity care, and suitable payment options before balances age.

5. Billing accuracy should be prevented upstream. Clinical documentation integrity, medical coding, and revenue integrity should reduce unsupported, missing, or duplicate charges. Ask how defects are intercepted before claims and statements.

6. Claims should be validated before submission. Claims editing and clean-claim validation should improve first-pass acceptance, while payment posting and reconciliation should allocate payer and patient responsibility correctly.

7. Patient communication should make action easier. Patient communication should be timely, plain-language, accessible, and consistent with HFMA’s 2024 Patient Financial Communications Best Practices, which connect a good financial experience with lower administrative cost, stronger results, and better patient decisions.

8. Technology should connect work, not fragment it. Revenue cycle execution systems and EHR integrations should connect EHR, payer, clearinghouse, workflow, and reporting data. Test exception visibility, data lineage, security, and human oversight.

9. Governance should expose causes and ownership. Open Accountability should define who owns an exception, when it escalates, and how learning returns upstream. A partner should show root-cause trends, corrective actions, and sustained results rather than activity counts.

10. Outcomes should unite patient and provider value. First-Pass Performance should reduce repeat touches and corrected bills while elevating patient experience, reducing cost to collect and accelerating cash.

A buyer scorecard turns promises into comparable evidence. | Score Operating Evidence

A credible evaluation tests evidence, governance, and fit. | Test Accountability

Ask partners to demonstrate three real workflows: an authorization exception, a changed estimate, and a denied claim transferred toward patient responsibility. Require each partner to show the data used, decision path, escalation, communication, correction, and root-cause feedback. Then validate reference-client results by care setting, payer mix, EHR, scope, and operating model. For example, this outsourced coding transition case study illustrates why disciplined transition governance and quality control matter when continuity and cash are at risk.

Score partners on measurable baselines and improvement commitments, not generic maturity claims. Useful measures include estimate accuracy, coverage discovery, authorization turnaround, eligibility and authorization denials, pre-bill interception, clean-claim rate, corrected statements, avoidable patient-balance transfers, inquiry resolution, financial-assistance screening, and cost to collect. Contract language should define data access, reporting cadence, escalation thresholds, patient communication standards, transition milestones, and ownership for corrective action.

Before contracting, examine how the partner will operate across each care setting. Enterprise health systems, ambulatory surgery centers, and physician practices and groups have different scheduling patterns, payer rules, coding complexity, patient-responsibility profiles, and integration constraints. Confirm that staffing, quality sampling, business-continuity planning, and governance reflect those differences. A strong partner should also explain which decisions remain with the provider, which are delegated, and how policy changes are translated into frontline workflows without disrupting patients.

The best partner does not promise to make every balance affordable. It helps the provider make every financial interaction more accurate, understandable, timely, and accountable. That operating discipline reduces rework, protects patient trust, and gives leaders a clearer path to transform revenue cycle performance without separating financial outcomes from the experience of the people receiving care.

At The Health Management Academy (THMA) Chief Revenue Cycle Officer Forum in Washington, D.C., one word connected conversations about turning Artificial Intelligence (AI) and workforce capacity into stronger performance: execution.

Today’s health systems have more ways to automate revenue cycle work, but technology doesn’t automatically improve cash flow. The financial return depends on whether rework is prevented, complex exceptions reach experienced people, and cleaner work carries through to payment.

The impact appears in denial volume, accounts receivable aging, cost-to-collect, and cash timing. Together, these outcomes determine whether technology investments strengthen forecast confidence and operating margin or create another layer of work to manage.

Disciplined execution improves First-Pass Performance. Weak execution gives rework a head start.

Here are our top six lessons learned from THMA about effective execution across the revenue cycle:

1. Solve the right problem first. | Solve the Right Problem First

‍Strong execution starts by identifying where performance breaks down, then deciding whether technology is the right answer. 

Not every revenue cycle problem needs AI. Sometimes the answer is a better workflow, clearer accountability, or simply getting the right teams on the same page. CROs need to understand what is causing the problem before committing resources to a solution.

That means tracing problems back to where they began, rather than fixing them wherever they happen to show up. A denial, for example, may originate in patient access long before a claim reaches the payer. The goal is to fix the source of the problem before adding technology on top of it.

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2. Balance scope and value in RCM solutions. | Balance Scope and Value

Point solutions and end-to-end solutions offer different paths to revenue cycle improvement. The challenge CROs at the forum shared is knowing when a targeted fix is enough and when broader coordination will deliver greater value.

Point solutions can address specific gaps quickly, such as coding accuracy or denial prioritization. Fully integrated solutions offer the potential to connect workflows, data, and accountability across the entire revenue cycle. Neither approach is automatically the better investment.

Leaders should weigh implementation complexity, integration requirements, total cost, and the financial impact of each option. A point solution that solves one problem but creates three new handoffs may not be much of a solution after all.

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3. Put expertise on the exceptions. | Put Expertise on the Exceptions

‍CROs at the forum agreed that AI creates the most value when it changes where people spend their time. Routine, rules-based tasks should move through technology, while experienced staff focus on exceptions where judgment protects reimbursement or prevents a costly delay.

This is where Human-in-the-Loop AI becomes essential. CROs need to identify which exceptions require specialized knowledge, how much staff time they consume, and where experienced employees can make the greatest difference.

In patient access, this means automating coverage checks while routing conflicting benefits, coordination-of-benefits issues, and payer-specific conditions to experienced staff. The financial test is lower eligibility denial exposure and fewer touches per resolved account, not how busy the bots appear.

The leadership decision is where human judgment produces the greatest incremental reimbursement, not where automation can generate the most activity.

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4. Govern what you intend to scale. | Govern What You Intend to Scale

‍As AI adoption grows, health systems need governance that goes beyond basic oversight. The challenge is establishing controls that protect reimbursement without limiting the value AI can deliver.

CROs discussed what effective AI governance looks like in their organizations:

• Setting performance thresholds based on error rates and reimbursement impact, with clear triggers for adjusting or pausing AI applications.
• Assigning clear accountability for AI-driven decisions, especially when errors affect claims or reimbursement, including who owns corrective action.
• Evaluating performance across specialties and payers to identify where differences in documentation or requirements introduce financial risk before expanding deployment.

Together, these actions help leaders make informed decisions about when AI is ready to scale and when intervention is necessary. 

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5. Plan for change before it arrives. | Plan for Change Before It Arrives

‍Revenue cycle requirements rarely stand still, and neither should the operating model. New payer rules, regulatory changes, and evolving AI capabilities can quickly change what effective execution looks like.

CROs should map how upcoming changes will affect the entire path to payment, not just the department responsible for implementing them. A new authorization requirement, for example, can affect scheduling, patient access, and claims. Understanding these dependencies early gives teams time to coordinate changes before they disrupt reimbursement.

The CRO’s change-readiness scorecard:

6. Measure what reaches the bottom line. | Measure What Reaches the Bottom Line

‍Getting more work done sounds like progress. The real question CROs are asking is whether the additional capacity produces a meaningful financial return.

Revenue cycle leaders can get a clearer picture by comparing automation costs against reductions in manual touches, denial-related rework, and collection times. First-Pass Performance gives leaders a clearer picture of how well accounts move through patient access, clinical documentation integrity, coding, claims, and denials. Fewer corrections mean less time fixing yesterday's work and more capacity to keep revenue moving.

The payoff should show up in lower cost-to-collect, shorter A/R cycles, and more predictable cash. After all, nobody invests in automation just to give their teams more work.

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Vee Healthtek builds accountability into execution. | Build Accountability into Execution

Vee Healthtek connects automation, workflow design, and practitioner judgment across the path to payment so execution stays tied to financial outcomes. We combine revenue cycle expertise with RevAmp, our AI-powered workflow management ecosystem, to turn revenue cycle rework into resilience.

Through Open Accountability, we take responsibility for results while health systems retain control and visibility. Leaders can see where performance stands, what is changing, and where intervention is needed before problems grow. By connecting workflows and building accountability into everyday operations, we help health systems move beyond reactive cleanup toward more consistent outcomes.

Patient affordability begins long before a statement is mailed. | Why Controls Matter

The patient affordability-centered revenue cycle is the set of operational controls that protects patients from avoidable financial harm across scheduling, registration, coverage, authorization, documentation, coding, claims, and billing. It does not change the clinical price of care or the patient’s benefit design. It does improve whether the right account, coverage, responsibility, estimate, and assistance pathway are established before an inaccurate or unexpected balance reaches the patient.

The need is material. A 2024 KFF analysis estimated that Americans owe at least $220 billion in medical debt; about 14 million adults owe more than $1,000. A separate 2024 KFF explanation of surprise bills noted that billing or plan-processing mistakes can still cause patients to be charged more than they should owe. These findings make accuracy, clarity, and timely resolution patient-protection priorities.

Ten controls can prevent financial harm before the bill. | Ten Preventive Controls

1. Match the patient to the correct record. Registration quality should validate identity and demographics at entry. AHIMA reported in 2024 that 45% of large hospitals had difficulty accurately identifying patients through electronic health information.

2. Verify coverage and benefits early. Eligibility and benefits verification should confirm active coverage, benefit limits, deductibles, coordination of benefits, and authorization indicators before service.

3. Discover available coverage. Insurance discovery can identify coverage that prevents an account from being classified as self-pay unnecessarily.

4. Secure authorization before care. Prior authorization should surface payer requirements, documentation gaps, pending decisions, and service changes before they cause delays or non-covered balances.

5. Set a reliable expectation. Price transparency and patient estimates should combine benefit information, contracted rates, known services, and clear assumptions. Estimates should be updated when the care plan changes.

6. Screen for appropriate assistance. Financial clearance and counseling should connect eligible patients with financial assistance, charity care, Medicaid screening, or suitable resolution pathways before balances age.

7. Make the record claim-ready. Clinical documentation integrity and health information management support should resolve missing or ambiguous information before coding and billing.

8. Protect coding and charge accuracy. Medical coding, charge capture optimization and revenue integrity should ensure the claim reflects documented care without omissions, duplication, or unsupported charges.

9. Validate the claim and responsibility. Clean-claim validation should stop preventable defects before submission, while payment posting and reconciliation should ensure payer and patient amounts are allocated correctly.

10. Communicate and resolve responsibly. Patient communication and self-pay, charity care, and Medicaid screening should give patients understandable information, accessible help, and a clear route to resolution. HFMA’s 2024 best practices link a good financial experience with lower administrative cost, stronger financial results, and better patient decisions.

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A control dashboard makes patient risk and ownership visible. | Make Ownership Visible

Open accountability keeps prevention from becoming another checklist. | Measure Patient Impact

Controls work only when exceptions have an owner, an escalation path, and a feedback loop. Open Accountability makes performance visible without taking control away from the provider. When a corrected statement, denied claim, or changed estimate is traced to its source, teams can remove the failure mode instead of normalizing rework. First-Pass Performance then becomes practical: complete the work correctly at the earliest appropriate step so patients and staff do not repeat it later.

The economic context strengthens the case. The American Hospital Association reported in 2024 that administrative costs exceeded 40% of hospital expenses and that commercial and Medicare Advantage care denials rose 20.2% and 55.7%, respectively, between 2022 and 2023. Downstream appeals remain necessary, but prevention reduces the avoidable touches, delays, and uncertainty that affect both provider finances and patient confidence.

Patient-centered measures show whether the controls are working. | Build Upstream Resilience

Executives should review record-match accuracy, eligibility-related denials, authorization turnaround, estimate accuracy, assistance-screening completion, pre-bill defect interception, clean-claim rate, avoidable patient-balance transfers, corrected statements, inquiry volume, and time to resolution. These measures connect elevating the patient experience with reducing cost to collect and transforming revenue cycle performance.

Providers should review patterns by payer, facility, service line, and control owner. This outsourced coding transition case study shows how visible governance, rapid workflow stabilization, and quality control can protect continuity while improving financial resilience. The same discipline applies to patient affordability: find where harm enters, correct the account, and redesign the control so the defect is less likely to recur.

A patient affordability-centered revenue cycle converts the abstract goal of affordability into ten governable controls. It protects clarity before care, accuracy before billing, and access to help before a balance becomes a crisis. Most importantly, it gives healthcare leaders a practical way to improve patient trust while strengthening first-pass operational and financial performance.

Healthcare affordability starts before the patient receives a bill. | Affordability Starts Upstream

Revenue Cycle Management (RCM) can support patient affordability by confirming coverage, identifying financial assistance, producing reliable estimates, preventing billing errors, and resolving insurance responsibility before balances reach patients. It does not directly reduce the clinical price of care. It does, however, limit avoidable financial harm created when administrative work is incomplete, inaccurate, or delayed.

That distinction matters. A 2024 KFF analysis estimated that Americans owe at least $220 billion in medical debt; about 14 million adults owe more than $1,000. For healthcare providers, affordability therefore includes not only what care costs, but whether patients receive correct coverage information, understandable estimates, accurate statements, and timely help.

Administrative errors can become patient financial problems. | Errors Become Patient Costs

A patient’s financial journey begins at scheduling, not collections. Incomplete registration can lead to failed eligibility and benefits verification. Missing authorization can delay care or shift uncertainty toward the patient. Documentation gaps, incorrect charges, coding errors, payer edits, and posting mistakes can produce denials or balances that require investigation before anyone can explain what the patient truly owes.

The system cost is substantial. The American Hospital Association reported in 2024 that administrative costs represented more than 40% of hospital expenses, while commercial and Medicare Advantage care denials rose 20.2% and 55.7%, respectively, between 2022 and 2023. Each preventable exception creates rework for staff and uncertainty for patients. Better denials management and appeals matters, but preventing defects earlier is more affordable than repeatedly correcting them downstream.

Eight revenue cycle practices can protect affordability. | Eight Preventive Practices

Healthcare providers can strengthen the patient financial experience through connected controls across the revenue cycle:

• Capture accurate demographics and insurance information through consistent patient access management.
• Verify eligibility, benefits, deductibles, and coordination of benefits before care whenever possible.
• Use prior authorization workflows that surface requirements early and escalate exceptions.
• Provide patient-specific estimates with plain-language explanations of assumptions and uncertainty.
• Screen for financial assistance and appropriate payment pathways before avoidable balances age.
• Strengthen medical coding, clinical documentation integrity and revenue integrity so claims and statements reflect the care delivered.
• Validate patient responsibility before statements are released, then reconcile payments accurately through payment posting.
• Use clear, concise, correct communications aligned with HFMA patient financial communication guidance.

A simple affordability control dashboard makes accountability visible.

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Providers should measure what patients experience. | Measure Patient Impact

Traditional revenue cycle measures remain important, but affordability requires a patient-centered scorecard. Leaders should monitor estimate accuracy, eligibility-related denials, authorization-related delays, pre-bill error interception, corrected statements, avoidable patient-balance transfers, inquiry volume, financial-assistance screening, and time to resolution. These indicators connect elevating patient experience with reducing cost to collect and improving revenue integrity.

They also make ownership visible. With Open Accountability, every exception should have a named owner, a defined escalation path, and a feedback loop to the step where the defect began. Technology can support this discipline by connecting EHRs, payers, clearinghouses, and teams through revenue cycle execution systems such as RevAmp and reliable EHR integrations.

First-pass performance turns administrative work into patient trust. | From Rework To Trust

Affordability improves when providers stop treating every error as an isolated downstream task. First-Pass Performance means completing work correctly upstream so patients and staff do not repeatedly revisit the same coverage, authorization, coding, claim, or billing issue. It helps reduce revenue leakage, accelerate cash and protect patients from avoidable confusion at the same time.

The operational lesson is simple: follow the patient balance upstream. A provider that can identify why an inaccurate or unexpected balance was created can redesign the process that produced it. This case study illustrates how a health system used agentic AI eligibility verification to reduce preventable eligibility denials by 26% and saved $3.6 million per month in the process. More broadly, transforming the revenue cycle requires connected workflows, transparent measures, and accountability for outcomes, not only activity.

For executives, the priority is not a collection of disconnected projects. It is a governed operating model that links the front, mid, and back office around a shared view of the patient account. Monthly reviews should examine where estimates changed, why responsibility shifted, which statements were corrected, and whether the originating defect was removed. Teams can then distinguish unavoidable complexity from preventable variation, direct resources toward the highest-impact breakdowns, and verify that automation improves accuracy rather than merely moving work faster. This creates a practical bridge between affordability, operational resilience, and financial sustainability.

Healthcare affordability is larger than revenue cycle management. Yet revenue cycle leaders control many moments that shape whether patients understand, trust, and can act on their financial information. When those moments work correctly the first time, providers reduce rework while giving patients greater clarity before, during, and after care.

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Re-engineering revenue cycle for the AI era.

Artificial intelligence is moving into coding, clinical documentation, authorization, analytics, and other parts of the revenue cycle. But in my work with healthcare leaders, I continue to see the same tension: technology can accelerate a process without correcting the design beneath it.

That tension framed “Back to First Principles: Re-Engineering the Revenue Cycle for the AI Era,” a Vee Healthtek webinar presented in partnership with Becker’s Healthcare. I had the opportunity to moderate a conversation with Dawn Castro of Surgery Partners, Shannan Bolton of Stanford Health Care, and Peter Thompson of UF Health. Together, we explored what revenue cycle leaders must reconsider before scaling AI.

My clearest takeaway was this: AI value begins with redesigning the work. Leaders need to understand why a process exists, where defects originate, how users experience the workflow, and which outcomes the technology is expected to change.

Start with the work, not the technology. | Start With the Work

Revenue cycle improvement often begins with a familiar question: how can we make the current process faster? Shannan challenged that starting point. Before optimizing or automating a workflow, leaders should ask whether the work should exist in its current form and whether the process was designed to prevent problems or manage them after they occur.

“Our first question is not how the work is done today, but why it should exist at all.”  
Shannan Bolton, Stanford Health Care

Denial management was a useful example. A workflow designed primarily to recover dollars after a claim fails may become more efficient without reducing the source of the denial. Shannan also noted that a result that remains consistent over time can point to the design, rather than an isolated execution issue. This shifts the conversation from who made an error to what the process repeatedly produces.

Fit AI to operational reality. | Fit AI to Operations

Dawn’s experience reinforced why a promising capability can still miss its expected value. An authorization use case may look attractive at an enterprise level, but performance can vary across service lines, payers, states, systems and user groups.

“What can you actually do today? Let’s focus on those service lines instead of the big, pie-in-the-sky opportunities.”
Dawn Castro, Surgery Partners

Her team’s work showed the importance of observing how people use technology in practice. Seat rides exposed integration gaps, repeated work and the trust issues that develop when users have experienced unreliable tools. The lesson for me is that AI adoption is not a communication task added after implementation. It must be designed into the workflow from the beginning.

Peter shared a related example from clinical documentation integrity. When an initial implementation did not sufficiently reflect clinicians’ day-to-day experience, the organization stepped back and involved clinician work groups in shaping the reimplementation. The technology had to fit the people and the work, not the other way around.

Move prevention upstream. | Move Prevention Upstream

The panel also returned to the need to move attention earlier in the revenue cycle. Recovery work will remain necessary, but leaders should not judge performance only by how effectively teams resolve downstream defects.

“There is a lot that we can do to prevent things from occurring in the first place.” 
Peter Thompson, UF Health

Peter described denial-prevention work groups that examine root causes and look for earlier intervention points. This idea connected with the measures discussed across the panel: revenue leakage, first-pass payment, yield, avoidable denials, speed to payment, and the percentage of accounts requiring human intervention. Each offers a different view, but all help leaders see whether redesign is reducing avoidable work or simply moving it faster.

A first-principles sequence for revenue cycle AI.

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Redesign roles and oversight. | Redesign Roles and Oversight

AI also changes the work people perform. Peter described a shift from completing tasks to auditing AI-generated output. That shift requires skills in exception management, quality review, and identifying when technology is not performing as expected.

“With AI, we’re moving people from being doers to being auditors.”
Peter Thompson, UF Health

Shannan discussed roles focused on automation leadership, workflow review, and post-launch monitoring. Dawn extended the point to product ownership, RFP discipline, and technology-vendor management. These are not supporting activities around AI. They are part of the operating model required to govern it with open accountability.

Retire low-value work. | Retire Low-Value Work

Re-engineering is also about deciding what to stop. Shannan described efforts to remove duplicate work queues, manual reconciliations, low-value reviews, and overlapping tools. The objective is not consolidation for its own sake. It is to create a less fragmented environment in which teams can act on insights instead of maintaining unnecessary activity.

What I would ask revenue cycle leaders to consider. | Leadership Takeaways

• Does the work still need to exist in its current form?
• Is the AI use case aligned with the users, service lines, payers and systems it will affect?
• Are we preventing avoidable defects or becoming faster at recovering from them?
• Who owns adoption, auditing and performance after the technology goes live?
• Which outcomes will show that the operating model has improved?

The organizations best positioned to scale AI will be those willing to question the work before automating it, involve the people closest to the process, retire unnecessary activity and make performance visible. That is the work behind an AI-ready revenue cycle.