Bradley Olson, Vice President of Managed Care for Mercyhealth, explains why revenue cycle leaders high claim denial rates to persist.
As payers increasingly rely on AI to adjudicate claims, providers should expect a high volume of denials for the next one to two years. To survive, health systems must adopt a more aggressive, technology-driven approach to combat the automation used against them.
Watch the clip below to hear more from Bradley Olson, Vice President of Managed Care for Mercyhealth.
Luke Gale is the revenue cycle editor for HealthLeaders.
KEY TAKEAWAYS
Payers are moving away from human auditors toward AI-driven validation, which has led to a significant spike in denials in the near term.
Providers must match the aggressiveness of payers by implementing automation and AI to defend their claims.
Despite the rise of automation, long-term success still requires collaboration between payers and providers to establish fair, consistent rules that prioritize patient care.