Points of view

One more edit. One more handoff. One more look at an account that was already reviewed. In large organization, those small touches disappear into the volume. In a rural health system, they add up to a real cost. 

At the Montana HFMA 2026 Fall Conference, speakers connected unnecessary work and rework to Medicaid uncertainty, artificial intelligence (AI), cybersecurity, and leadership. Each pointed to the same goal: making every resource count without compromising financial performance.

Here are my top five top insights from the Montana HFMA conference for rural health leaders.

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1. Strong leadership stretches limited capacity. | Leadership Makes Capacity Work

Rural health systems cannot hire their way out of every staffing challenge. Matt Griswold, speaker, author, and musician, talked about the importance of knowing when to lead and when to support in his “Harmony & Melody” keynote presentation.

His musical analogy offered a useful lesson about team dynamics. In music, the melody takes the lead while the harmony supports and strengthens it. Both are essential to the performance. The same idea applies to health system operations. Effective teams know who needs to step forward on a task, when others need to step in, and how their work supports a shared result.

For rural health systems, this means knowing who takes the lead as work moves between departments. Consider a claim delayed by missing clinical documentation. Coding identifies the gap, clinical staff take the lead in resolving it, and billing steps forward once the claim is ready. The melody shifts between teams, while everyone else provides the support needed to keep the work moving. Each team has a different part to play, but everyone needs to follow the same plan. 

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‍‍2. Rework drains rural capacity. | Small Teams Need Smarter Queues

‍Rural health system executives highlighted how manual payment posting, paper-based authorization processes, and repeated account touches consume valuable staff time without adding financial value. When these workflows fall out of sync, errors and unnecessary handoffs create avoidable rework.

Putting emphasis on reducing repeated corrections helps health systems reclaim capacity. Accurate patient information at registration, clearer coding work queues, and timely payment posting help prevent avoidable rework and identify denials sooner. The less time employees spend revisiting the same accounts, the more capacity they have to resolve outstanding claims, accelerate reimbursement, and protect cash flow. First-Pass Performance is how rural teams turn rework into resilience.

Where rural health systems can regain capacity:

3. AI needs to prove its value. | AI Needs a Practical Starting Point

‍AI generated plenty of interest at Montana HFMA, but one question stood out: where can rural health systems put it to work without adding complexity or cost? With limited budgets and lean teams, technology investments need a clear operational purpose and measurable financial return.

The best starting point is a focused revenue cycle workflow, such as prioritizing claims for follow-up or identifying documentation gaps. Before expanding, leaders need to establish accountability, validate accuracy, and measure whether automation actually reduces staff workload. Faster processing means little if employees spend the time they saved correcting errors.

The real test comes after implementation. Approved tools, human oversight, and clear escalation procedures help keep AI reliable as workloads and exceptions change. 

4. Medicaid uncertainty threatens rural cash flow. | Coverage Risk Starts Upstream

‍One of the biggest financial concerns raised by executives was Medicaid uncertainty. Changes in eligibility requirements create a real risk for rural health systems and put additional pressure on already tight margins. 

Timing makes all the difference, since identifying coverage gaps before service gives rural health systems more options to protect reimbursement. Stronger eligibility verification, accurate registration, and timely prior authorization help prevent avoidable denials, while early financial counseling gives patients a chance to address coverage gaps. Once an account reaches collections, the health system has fewer options and has already absorbed the cost of additional work.
 

5. Cybersecurity is a cash issue. | Cybersecurity Is a Cash Issue

‍One of the more sobering discussions at Montana HFMA centered on phishing and payment fraud. Attendees shared experiences that underscored the financial risks facing rural health systems, where a single fraudulent transaction can put significant pressure on limited cash reserves and disrupt essential operations.

For rural health systems especially, cybersecurity deserves a place in the broader conversation about financial resilience. Independent verification of banking changes, restricted system access, and clear incident response procedures help protect cash and maintain business continuity. 

Finance and IT leaders also need defined responsibilities for identifying suspicious transactions, escalating concerns, and authorizing payments. A simple verification step can prevent a costly financial loss and weeks of disruption. For rural health systems operating with limited resources, prevention is far more manageable than recovery.

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What I took home. | What I Took Home

Just as a successful musical performance depends on everyone playing their part, rural health systems need their people, processes, and technology working in sync. 

For healthcare leaders, stronger performance begins with recognizing where coordination breaks down and addressing the causes. Preventing Medicaid-related denials, reducing unnecessary work, and introducing AI responsibly all depend on clear ownership and making better use of existing resources.

Rural health systems don’t need every department playing louder. They need everyone playing together to protect cash flow, strengthen margins, and make limited capacity go further.

Key Takeaways

• Coverage checks before service help protect reimbursement and reduce avoidable denials.
• Exception-based queues direct limited staff time toward accounts with cash impact.
• Small AI pilots need accuracy checks and explicit ownership before expansion.
• Payment-change verification and incident readiness support business continuity.
• Clear handoffs make shared expertise more useful to rural teams.
  

Patients never see an organization chart, but they feel every handoff between its departments. When information stalls between steps, or no one owns the gap, patients absorb the confusion and the organization absorbs the rework.

Panelists at the 2026 New Jersey & Metro Philadelphia HFMA 50th Annual Institute named this fragmentation as a leading source of patient frustration. Whether the topic was estimates, denials, automation, or payment, the problem and the fix both lived in the handoff.

These five takeaways each name a handoff, and what leaders can do to keep it from becoming the patient's problem.

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1. Estimate accuracy decides whether patients trust the final bill. | Estimate Accuracy Matters

The patient financial experience panel, with leaders from Penn Medicine Princeton Health, Hackensack Meridian Health, Cooper University Health Care, and Holy Name Medical Center, called estimate accuracy critical but rarely measured. An estimate is a promise made at scheduling and registration and kept or broken later by a different team. 

The panel compared an estimate to a car repair quote, and the analogy stuck with me: when quote and final bill diverge, trust takes the hit. Billing problems often overshadow good clinical care, so organizations were encouraged to adjust bills within a reasonable range, while price transparency laws raise the stakes for accurate quotes.

2. Registration-driven and payer-driven denials need different fixes. | Identify Denial Sources

Panelists called denials a growing drag on payment and staff time, led by front-end and coordination of benefits denials, and said payers use them to delay payment. This creates two lanes. In one, registration creates the denial through outdated eligibility data or a missed secondary payer. In the other, payer behavior does, and industry groups are pursuing regulatory action.

One published review of 240 eligibility denials traced top causes to missing documentation, incorrect insurance and demographic data, and manual delays. Tagging each denial by lane shows which preventable denials need registration staff education and which belong in payer escalation, so denials leaders know who owns the fix.

3. Design the exception path before automating routine work. | Design Exception Paths

Audience polls put denial management, authorizations, and claim status updates atop the automation list. Payers already use artificial intelligence (AI) to increase denials, and patients are increasingly using ChatGPT to dispute bills, so disputes can outrun a manual queue. Executives agreed that automation offers the best method to answer AI-driven denials faster and more accurately.

Panelists drew the line at relationships: digital tools should enhance the human element rather than replace it. The handoff between machine and person is the design problem, so teams should redesign the workflow and its exception path before automating routine work. Otherwise, automation has simply built a faster queue.

4. Familiar, well-timed payment options bring in more cash. | Simplify Patient Payments

One speaker reported a 400% increase in emergency department (ED) copay collections after moving to tablet-based registration. The tablets improved registration accuracy and eased the emotional burden on staff handling payment conversations.

Adoption follows trust, so digital payment options should be familiar. Discounts around tax season or year-end and installment plans built to Medical Debt Relief Act guidelines meet patients when they can pay. Each tactic also lowers cost-to-collect when it replaces a statement cycle or follow-up call, a result finance leaders can verify.

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5. Write patient standards into every collection partner agreement. | Set Partner Standards

Speakers in a second session described the partners who support collections and payment as patient advocates offering consistent, empathetic help. Once an account moves, patients hear the organization's voice through that partner, and negative experiences carry a disproportionate reputational cost.

Four terms belong in every partner agreement:

• Shared communication records, so patients never retell their story
• Unified messaging across every channel
• Human responses to digital outreach
• Early identification of self-pay patients who qualify for aid

It’s important to review partners against recovery rate, bad debt percentage, and patient satisfaction together, so recovery gains never hide a damaged relationship.

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Own the handoffs. | Own the Handoffs

Estimates, denials, automation, payment, and partners looked like five separate problems, but each came down to whether information and ownership crossed the gap intact. Patients judge the whole organization by how that moment feels, and a department-level dashboard never captures it. Leaders who follow one patient from scheduling to statement, and name an owner at every seam, will see exactly where trust and cash slip away.

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Key Takeaways

• Estimate accuracy and first-call resolution show whether promises and answers survive handoffs, before gaps become disputes and rework. 
• Tagging denials by origin sends registration-driven losses to training and payer-driven losses to escalation. 
• Automation answers payer AI and patient disputes only when exceptions have a trained human owner. 
• Familiar, well-timed payment options lifted one organization's emergency department copay collections 400%, and lower cost-to-collect when they replace a follow-up call.
• Partner agreements requiring shared records, unified messaging, and human responses protect patient trust alongside recovery rates.

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.