Mercy is reengineering its revenue cycle strategy to reduce preventable denials, counter increasingly aggressive payer algorithms, and elevate the role of its workforce.
Revenue cycle transformation is increasingly being shaped by two competing forces: rising patient expectations and growing payer scrutiny. At Mercy, those pressures are converging into a deliberate strategy to redesign how revenue cycle operations function.
Sterling Coker, Chief Revenue Cycle Officer at Mercy, is leading that shift by positioning the patient experience as equally critical to financial performance.
For the 55-hospital system, that means moving upstream to prevent denials, deploying automation to respond to payer behavior, and redefining workforce roles to support a more analytical, technology-enabled revenue cycle.
Winning on the Front End
With patient financial responsibility on the rise and payers turning their focus upstream, pre-service workflows matter more than ever before. With nearly one-half of denials now originating in the front end, Mercy has turned its attention to upstream accuracy to resolve eligibility, authorization, and financial clearance before care is delivered.
"The front end is absolutely where we need to focus for the benefit of the patient,” Coker says.
As a faith-based organization, the health system maintains a strong commitment to protecting patient dignity, according to Coker. By screening patients for financial assistance in advance, Mercy avoids potentially embarrassing financial conversations at the front desk.
Additionally, to help patients understand complex payment schemes, Mercy’s revenue cycle team is working to exceed industry standards for uncertain price estimates by delivering accurate price quotes to build trust and reduce post-care friction.
The Battle of the Bots
While front-end optimization secures patient trust and limits problems downstream, payer friction still remains in the backend. As insurance companies aggressively deploy AI and algorithmic reviews, physicians and healthcare providers are facing an unprecedented administrative burden. Coker highlights a growing trend of algorithmically generated medical record requests and claims denials.
In one state alone, a single payer generated over 10,000 medical record requests for Mercy, effectively delaying payments for administrative reasons rather than actual care or coding errors. Additionally, this one specific denial type is highly likely to be overturned on appeal.
"So why deny it if you're going to overturn it 84% of the time?" Coker asks. "It creates friction for everyone and administrative waste for everyone... And the patient's caught in the middle of it, with the payer knowing that the provider will not pursue it in many cases."
To counter this friction, Mercy has developed its own automated tools to autonomously pull and submit medical records in response to payer AI. "That becomes a perfect example of the battle of the bots," Coker says. "Their bot is requesting records and our bots are sending the fulfillment of that record request so the patient gets the care they need."
Workforce Evolution and Modernization
To support modern revenue cycle operations Mercy is actively looking at ways to upskill staff. Rather than focusing purely on manual processing, staff must now act strategically to manage complex payer behavior.
"We're having to, by necessity, become a more tech-driven, analytical environment than maybe in the past," Coker says. "In the past, it was much more focused just on transaction. Now we need to be much more analytical and strategic."
This evolution requires revenue cycle teams to form closer partnerships with payer contracting departments, allowing them to reflect provider concerns and collaborate directly with payers to resolve operational challenges.
As staff take on these complex negotiations, new technology manages routine patient access tasks. The health system recently rolled out automated tools to conduct inpatient Medicaid eligibility screening before clinical staff visit a patient's room. Additionally, Mercy is developing an AI-powered voice and chat solution for its call center to alleviate extended hold times during peak hours.
The Bottom Line
Ultimately, Mercy’s strategy demonstrates that financial efficiency and patient empathy are not mutually exclusive. By pushing complex administrative work upstream, automating responses to aggressive payer algorithms, and treating the financial experience as an extension of clinical care, health systems can protect their margins while preserving the dignity of the communities they serve.
As Coker emphasizes, if a health system designs its revenue cycle around the patient, the operational improvements will naturally follow.
Luke Gale is the revenue cycle editor for HealthLeaders.
KEY TAKEAWAYS
With around half of denials originating on the front end, Mercy focuses on upstream accuracy for financial clearance to protect margins and preserve patient dignity.
To combat a deluge of AI-generated payer denials and record requests, the health system developed its own automated tools to autonomously pull and submit medical records.
As new technology automates routine patient access tasks, Mercy is upskilling its revenue cycle workforce to handle more complex tasks.