Is The Healthcare System Quietly Falling Apart… And Nobody’s Talking About It?
Mark Alyn speaks with MedEvolve CEO Matt Seefeld about why the U.S. healthcare system is confusing, inefficient, & under strain.
San Francisco, CA — April 13, 2026 Payer denials are doing more than slowing reimbursement, they are creating a significant but often unmeasured administrative burden that can delay resolution, increase confusion, and contribute to friction in the patient experience.
New touch-level benchmarks from MedEvolve track each staff interaction required to move a claim from submission to payment to quantify what the company calls the “denials tax,” the hidden work created by payer friction and preventable process breakdowns.
MedEvolve’s analysis shows that the true cost of denials extends beyond delayed or lost revenue. Each denied or disrupted claim can require multiple follow-ups across billing teams, clinical staff, and payer communication channels. Even when claims are ultimately paid, the cumulative effort required to resolve them slows workflows, extends timelines, and diverts resources away from patient-facing priorities.
“Denial rates alone do not capture how much work it actually takes to get paid or how that work impacts the broader care experience,” said Matt Seefeld, CEO of MedEvolve. “Even when a claim is reimbursed, if it required multiple staff interactions to get paid, that represents time and effort that could have been directed elsewhere, including supporting patients.”
While denial rates remain a standard industry benchmark, MedEvolve’s findings show that the administrative workload associated with each claim may be a more meaningful indicator of operational performance.
Denial categories such as authorization failures, eligibility issues, and documentation requests often trigger repeated payer portal follow-ups, insurer calls, and documentation resubmissions. Across thousands of claims, that work creates a substantial but often unmeasured operational burden that slows resolution and prolongs the billing process for providers and patients.
Additionally, denial reason codes may lack clarity around recoverability. Documentation may be required even when outcomes rarely change, and delays in rework can increase exposure to timely filing limits. Organizations also often lack visibility into the relationship between effort and financial yield.
“The real issue is not just the denial itself,” Seefeld said. “It is the chain reaction of work required to investigate, document, and resolve it. That is the “denials tax”—and it has ripple effects beyond the back office.”
Many of the issues that generate denial-related workload begin before a claim is ever submitted. More than half of denials are caused by gaps in eligibility verification, coordination of benefits, prior authorization, and documentation collection creating avoidable downstream work for revenue cycle teams.
When these issues are not resolved upfront, the burden shifts to the back end through claim correction, payer follow-up, documentation resubmissions, and appeals. The result is a growing number of touchpoints required to move claims forward and a heavier administrative load across the organization. And for patients, these same breakdowns can lead to unexpected bills, confusion around coverage, and potential care delays tied to authorization or documentation requirements.
To reduce denials effectively, leaders need visibility into where those breakdowns begin so the appropriate teams, from the front office to coding and clinical documentation, can correct issues upstream before they create downstream rework.
As AI adoption accelerates across healthcare, many solutions promise to reduce human involvement in the revenue cycle but, in some cases, these technologies may be contributing to the very denials they aim to prevent.
“When we examine the number of touches and the administrative burden required to overturn denials caused by upstream errors, eligibility, coordination of benefits (COB), and prior authorizations, historically these were human errors,” said Seefeld. “Now we’re seeing instances where they originate from the AI and automation tools organizations have implemented to streamline the revenue cycle.”
The problem is that many AI and automation solutions in healthcare are one-directional. They accomplish a job, but often there is no reporting on the outcome. Without this visibility, organizations are unable to systematically identify root causes or distinguish between human and machine-driven errors.
To effectively reduce denials, healthcare leaders must leverage advanced analytics that not only pinpoint root causes but also drive continuous improvement across both human workflows and automated processes. Establishing this feedback loop is essential to preventing denials before they occur, rather than simply managing them after the fact.
Industry benchmarks continue to focus on lagging financial indicators such as denial rate, clean claim rate, and days in accounts receivable. While useful, these measures do not reflect how frequently staff must intervene to correct, resubmit, or resolve claims—or how those delays extend the billing journey for patients.
MedEvolve’s approach instead focuses on the operational work required to move claims to resolution. Through its Effective Intelligence® Suite, the company captures and analyzes every human touch required to adjudicate a claim, providing visibility into how work actually gets done across the revenue cycle.
Using proprietary benchmarks built on touch-to-outcome data, organizations can identify where processes are breaking down, understand which activities drive results, and measure performance based on objective operational facts rather than lagging financial indicators.
“In many organizations, the operational burden behind reimbursement is far greater than leadership understands,” Seefeld said. “That burden doesn’t just affect efficiency—it can extend timelines and create additional friction throughout the patient financial experience.”
Although payer-related administrative burden affects healthcare organizations across the board, rural hospitals and other resource-constrained providers are often less equipped to absorb the repeated rework denials create.
With limited staff and tighter financial margins, the cumulative effect of denial-related work adds stress to already constrained operations, making it more difficult to sustain access to care within their communities. Reducing avoidable administrative workload is critical not only for operational efficiency, but for maintaining access to services patients rely on.
MedEvolve’s touch-level benchmarks introduce new operational indicators designed to help healthcare leaders measure denial-related workload and identify opportunities for improvement. Key metrics include:
These measures provide visibility into where administrative effort is concentrated and where payer policies or internal workflows may be driving unnecessary work. By improving front-end accuracy and increasing zero-touch claims, organizations can reduce avoidable rework, accelerate resolution, and create a more consistent experience for both staff and patients.
“Healthcare organizations are not just managing denials; they are managing the work created by them,” Seefeld said. “Reducing that work is key to improving both operational performance and the full patient experience.”
MedEvolve is rewriting the rules of the revenue cycle, helping healthcare organizations move beyond labor-intensive, reactive reimbursement work. Its Effective Intelligence® (Ei) platform provides visibility into the operational activity behind reimbursement, enabling leaders to identify avoidable effort, streamline workflows, and support scalable automation.
By reducing unnecessary touches and improving process control, MedEvolve helps organizations accelerate resolution, increase predictability, and operate more efficiently in an increasingly complex payer environment.
References
Matt Seefeld, Chief Executive Officer at MedEvolve, brings over 24 years of management consulting experience in the healthcare industry. He has extensive expertise in the assessment, design and implementation of process improvement programs and technology development across the entire revenue cycle. Matt began his career with Stockamp & Associates, Inc. and worked for both PricewaterhouseCoopers LLP and Deloitte Consulting LLP in their healthcare and life sciences practice lines. In 2007, he developed a business intelligence solution and founded Interpoint Partners, LLC, where he served as Chairman and Chief Executive Officer. In 2011, he sold his business to Streamline Health Solutions where he then served as Chief Strategist of Revenue Cycle followed by Senior Vice President of Solutions Strategy until 2014. Matt ran global sales for NantHealth and provided consulting services for healthcare technology and service businesses nationwide, prior to joining MedEvolve full-time.
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Mark Alyn speaks with MedEvolve CEO Matt Seefeld about why the U.S. healthcare system is confusing, inefficient, & under strain.
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