Rethinking Denials: Insights from the 2026 HealthLeaders Rev Cycle Exchange

While complaints about payer behavior are fair game, health systems need to turn to areas they can control to manage denials.

While payers have become increasingly heavy-handed when it comes to paying claims, health systems can’t point their finger across the aisle for every denial.

During the recent HealthLeaders Revenue Cycle Exchange in Sarasota, Florida, one roundtable discussion focused on a pain point that impacts every health system’s financial health: Denials. And participants were clear in saying they have to take action rather than just blaming payers.

While payers can’t control a payer’s algorithm, they can limit internal knowledge gaps and ineffective workflows that lead to high denial rates.

“Denials due to knowledge gaps for staff and remedial training—that’s something we’re heavily focusing on,” said Paul LePage, Vice President of Revenue Cycle at UC Davis Health.

Here are four ways that revenue cycle leaders are rethinking their denial defense to fix what they can control.

Closing the Knowledge Gap

All the technology in the world won’t help decrease denials if staff don’t know how to use it effectively. Roundtable participants agreed that internal deficiencies, whether in registration, authorization, or coding, often lead to denials downstream.

At one organization, leadership is installing supervisors at each site of care to manage authorizations directly, creating a specialized layer of leadership to catch errors before they become denials.

However, it’s not just frontline staff who are struggling. One executive shared that senior leadership within their organization lacked the ability to track denials in granular detail. “They can't run the basic reports to even be able to investigate," the executive said. "I am personally training leaders on how to access these.”

Integrating Clinicians into the Rev Cycle

For many health systems, medical necessity denials are a top barrier to reimbursement. To improve performance, RCM leaders are restructuring their org charts to bring clinical teams directly under the revenue cycle umbrella.

"We’re breaking down the silo," said one executive, who recently moved Physician Advisors and Case Management to report directly to Revenue Cycle. "This is going to be the clinical part of revenue cycle, and that’s been something doctors are listening to.”

The idea is that doctors will listen when it’s a peer explaining how documentation impacts the organizational ability to defend care that’s been delivered.   

Rethinking Payer Contracts

Fighting denials retroactively, after a patient has left, is an expensive, losing battle. Several participants shared how they are using contracts to force payers to deny concurrently or to lose the right to deny later.

This strategy involves writing contracts that require payers to issue medical necessity denials while patients are still in the hospital. By forcing the fight to happen in real-time, health systems can utilize peer-to-peer reviews while the clinical details are fresh.

Holding Payers Accountable to the Law

Many states are establishing new rules to limit denials and delays, but payers aren’t necessarily following them.

In California, a new law requires health plans to pay or contest claims within 30 calendar days of receipt, including weekends and holidays.

"They're already not doing it," LePage said. "So, we're kind of finding ways to track interest and kind of hold them accountable for that.”