RCM Effective Intelligence

In this guide, we break down why denial rate stops being useful once a team is already hitting it and what to track instead. You’ll see how a claim that’s never denied can still take six touches and multiple people to get paid, why the industry’s own denial-touch benchmark is missed by a factor of three, and how one ambulatory surgery center management company cut denials 18% and labor dependence 30% by treating claims, denials, and cost as one connected problem.

A team can spend 40 hours resolving 200 claims, watch 180 of them pay, and still report a comfortable 8 percent denial rate. That number doesn’t tell you what it cost to get there.

In this guide, we break down why denial rate stops being useful once a team is already hitting it and what to track instead. You’ll see how a claim that’s never denied can still take six touches and multiple people to get paid, why the industry’s own denial-touch benchmark is missed by a factor of three, and how one ambulatory surgery center management company cut denials 18% and labor dependence 30% by treating claims, denials, and cost as one connected problem.

Hospitals and health systems spend an estimated $40 billion a year on billing and collections. A system replacement changes the interface, not necessarily the economics.

In this guide, MedEvolve breaks down why a billing system replacement can leave the real problem untouched. You’ll learn how to tell whether your cost to collect is a platform issue or a workflow issue, how to prioritize claims by financial risk instead of age or balance, and how one MedEvolve customer grew to nine new centers without adding headcount by fixing the work, not the software.

Most AI vendor pitches are built around task-completion metrics: claims processed, calls placed, codes assigned, denials ‘worked.’ These numbers are easy to demo and easy to report. They are also, on their own, meaningless.

Provider organizations should adopt new methodologies for revenue cycle benchmarks to understand staff effectiveness and where breakdowns are occurring. These include the following measures along with suggested percentages for optimizing revenue cycle processes.

Provider organizations should adopt new methodologies for revenue cycle benchmarks to understand staff effectiveness and where breakdowns are occurring. These include the following measures along with suggested percentages for optimizing revenue cycle processes.