The payer-provider war is entering a new phase, and the financial fallout is devastating. CFOs are no longer just balancing budgets—they are the last line of defense against aggressive payer tactics.
Welcome to the HealthLeaders March 2025 cover story. Each month, our editors dive into the topics that matter most—such as healthcare innovation, leadership strategies, and patient care—delivered in a dynamic, engaging format.
What did we look at this month? It’s all about the escalation of the payer/provider war.
Seventy percent. That’s how much payer-provider disputes have surged in just the last two years.
Contract terminations, lawsuits, and drawn-out reimbursement battles have become the new normal, and hospitals are bleeding cash as a result.
Providers now spend nearly $20 billion annually on claim denials—half of it wasted on disputes that should never have happened. That’s $10 billion that could have gone toward patient care, medical innovation, or staff retention. Instead, it’s being siphoned away in an endless cycle of bureaucratic gridlock.
But this war is evolving. Payers are using AI-driven denials to reject claims at unprecedented rates. Legal battles over reimbursement are intensifying. Patients, caught in the crossfire, are angrier than ever. And yet, policymakers remain largely disconnected from the financial devastation unraveling in hospitals across the country.
If this battle remains an “I win, you lose” game, providers will continue losing billions, patients will suffer, and health systems will collapse under the weight of financial instability. The system is unsustainable—but it’s not unfixable.
CFOs are in a rare position to rewrite the rules of engagement. By standing at the intersection of finance, operations, and policy, they can wield hard data to expose payer tactics, drive regulatory changes, and force a shift in how contracts are negotiated. But to do that, they must step beyond the walls of their own health systems and enter the policy arena.
This month, CFO editor Marie Defreitas writes about how CFOs can stop reacting and start leading.
The frontier of clinical AI isn't just emerging—it's exploding, reshaping the very fabric of healthcare with both exhilarating promise and perilous uncertainty.
Picture a landscape as uncharted and volatile as the Wild West, where the stakes are nothing less than patient lives, clinical integrity, and the future of medical practice. Here, algorithms are the new outlaws and innovators, disrupting traditional workflows, challenging the sanctity of clinical decision-making, and daring to redefine the doctor-patient dynamic.
While AI has comfortably nestled into administrative corners, trimming inefficiencies and enhancing operational flow, its march into clinical territories is met with a starkly different reality. This isn’t about automating paperwork; it’s about influencing diagnoses, treatment plans, and even patient trust. What happens when AI crosses the line from assistant to authority? When it prescribes medication or becomes the voice patients heed over their own physicians?
The HealthLeaders 2024 AI in Clinical Care Mastermind program, sponsored by Ambience, Microsoft, and Rapid AI, convened clinical trailblazers from 10 health systems to grapple with these very questions. Their candid discussions reveal not just early victories in radiology and patient communication, but also the raw, unvarnished struggles: navigating governance without stifling innovation, integrating AI without alienating clinicians, and chasing ROI amidst ethical gray zones.
This report distills their hard-won insights, offering a compass for healthcare leaders navigating their own AI frontiers. Here, you'll find not just lessons learned, but survival strategies for thriving in an era where clinical AI isn’t a distant future—it’s the reality unfolding in exam rooms, operating theaters, and patient portals today.
During these uncertain times, health systems won't embrace new technology unless there's a firm understanding of ROI attached. Here's how to find it.
When it comes to new technology, healthcare leaders need a good, sound business plan to move forward.
This is especially true with virtual care, which was the sweetheart of the rodeo during the pandemic, when providers needed to reduce pressure on hospitals and patients wanted to access care from home. Federal and state regulators even reduced telehealth restrictions to allow more access, and payers like CMS relaxed their rules to reimburse for more virtual care services.
But now that the pandemic has passed, the pendulum has swung back. Many COVID-era waivers have expired, patients are expressing a desire to see their doctors in person, and healthcare executives are tasked with revising or even redefining how virtual care services can be sustained and scaled.
So how do health systems and hospitals define the ROI of a telehealth platform or digital health tool in this day and age? Clinical outcomes, provider workflows and workforce shortages are all part of the recipe, but there also has to be a financial benefit. Can all of these interests co-exist in a business plan?
In this webinar, HealthLeaders takes a deep dive into this issue with David Higginson, EVP and Chief Innovation Officer at Phoenix Children’s Hospital, and Stephen Hunter, VP of Digital Strategy and Innovation for the Allegheny Health Network, part of Highmark Health.
The healthcare workforce is in crisis, and revenue cycle leaders are feeling the pain too.
Across hospitals and health systems, staffing shortages, high turnover rates, and an increasingly fickle workforce are making it harder than ever to maintain financial stability.
The revenue cycle is the backbone of a hospital’s financial health—if billing, coding, and patient access teams aren’t fully staffed and engaged, the entire operation suffers. Leaders are in a fight for talent, and the battle is getting tougher by the day.
This was a huge topic of conversation for more than the two dozen revenue cycle leaders from hospitals and health systems across the country that gathered for this year’s Revenue Cycle Exchange.
Here’s how the revenue cycle leaders at this year’s February event in San Antionio, Texas, are striving to make a difference in their organizations’ workforce.
Why Is It So Hard to Fill Revenue Cycle Jobs?
Hiring in healthcare has always been challenging, but the current environment is unprecedented. Despite aggressive recruitment efforts and increased advertising, revenue cycle leaders are struggling to get qualified candidates through the door. And when they do? Many candidates ghost them before the first day or leave after just a few months, the attendees said.
Is it salary? Is it generational differences? The answers aren’t clear-cut.
While competitive wages are always a factor, today’s workforce also prioritizes flexibility, work-life balance, and remote opportunities.
Revenue cycle leaders at the event said they are now competing not just with local hospitals but with systems across the country that can offer fully remote positions. If a coder in a small town can make the same or more money working for a large hospital system in another state without ever leaving their home, why wouldn’t they take that opportunity?
To combat this, some leaders at the event are considering alternative pay structures, including performance-based benefits and increased incentives for hard-to-fill roles.
Keeping Staff from Walking Out the Door
Hiring is only half the battle—keeping employees engaged is proving just as difficult.
Hospital leaders at the event say they are spending enormous amounts of time and resources on training, only to see staff leave within months. The cycle is exhausting and costly.
One major issue is a lack of commitment, one executive said. Some employees jump at the first better offer, while others disengage due to a lack of appreciation. Employee engagement is no longer a nice-to-have—it’s a survival strategy. Revenue cycle leaders are pushing for more meaningful recognition programs, ensuring staff feel valued beyond just a paycheck.
However, there’s a fine line to walk.
Leaders stressed that while it’s important to communicate appreciation, discussing bonuses openly can backfire. Expectations can spiral out of control, and if employees feel entitled to rewards rather than motivated by them, the entire system collapses.
Instead, transparency about performance metrics and incentives is proving to be a more effective approach.
Pictured: Revenue cycle execs talk shop at the 2025 Revenue Cycle Exchange in San Antonio, TX.
Preparing for the Inevitable
Even the best employees won’t stay forever.
Without a strong succession plan, revenue cycle teams are at risk of collapsing when key leaders move on. The industry is seeing a wave of retirements, and younger professionals aren’t always ready to step up.
Forward-thinking revenue cycle leaders are proactively identifying future managers and equipping them with the skills they need before a leadership vacuum emerges. Training programs, mentorship, and leadership development initiatives are becoming essential tools in preventing chaos when experienced leaders leave.
Another strategy is focusing on hiring candidates with both technical experience and soft skills.
“While technical proficiency can be taught, emotional intelligence, communication, and adaptability are harder to instill,” one leader said.
Hospitals are prioritizing well-rounded candidates who not only understand the numbers but can also lead teams effectively.
The Remote Work Debate: Solution or Setback?
Remote work has changed the game for revenue cycle leaders, they say.
While it offers a solution to staffing shortages by allowing hospitals to hire beyond their immediate geographic area, it also introduces new challenges. Some leaders argue that remote work has made employees less engaged, while others see it as the key to long-term retention.
The reality is that remote work is here to stay, and revenue cycle teams must adapt.
The focus now is on measuring productivity transparently and setting clear expectations for remote employees. Leaders who find ways to balance flexibility with accountability will have the best shot at retaining top talent.
But for hospitals in small markets, the competition is brutal. It’s no longer just about catching “epic talent” in a local area—now they have to compete with national systems that can offer fully remote roles.
The playing field has changed, and leaders are forced to rethink their entire approach to staffing.
Are We Meeting the Needs of a Changing Generation?
A generational shift is shaking up the revenue cycle workforce.
Younger employees are demanding different work environments, often pushing for higher wages, shorter hours, and more flexibility. Some leaders question whether hospitals should meet these demands or push back against what they see as unrealistic expectations.
One thing is certain: the workforce has changed, and hospitals must evolve with it. Some revenue cycle leaders are experimenting with alternative work schedules and flexible hours to accommodate different needs.
The challenge is finding the right balance between meeting employee expectations and maintaining financial stability.
What else?
Well, social media and the internet have also reshaped how employees view work, they say.
Many younger professionals have a skewed perception of salaries and job expectations, leading to difficult negotiations. Revenue cycle leaders must be strategic about compensation—offering competitive packages without getting caught in expensive bidding wars over minor salary differences.
How to fight for a Stronger Revenue Cycle Workforce
The healthcare revenue cycle workforce crisis isn’t going away anytime soon, but top-performing leaders are proving that it can be managed.
By pushing innovative recruitment strategies, prioritizing retention efforts, and rethinking workforce expectations, they are slowly turning the tide.
The fight for talent is fierce, but the solution isn’t just throwing more money at the problem.
True success lies in creating an engaged, motivated workforce that sees the revenue cycle as a career, not just a job. Leaders who embrace change, invest in their teams, and remain flexible in
their approach will be the ones who come out on top. For hospitals and health systems, the time to act is now—because without a strong revenue cycle team, the entire operation is at risk.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
To inquire about attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
In a social media landscape shaped by hashtags, algorithms, and viral posts, nurse leaders must decide: Will they let the narrative spiral, or can they adapt and join the conversation?
Welcome to the HealthLeaders February 2025 cover story. Each month, our editors dive into the topics that matter most—such as healthcare innovation, leadership strategies, payer/provider wars, and patient care—delivered in a dynamic, engaging format.
What did we look at this month? It’s all about "NurseTok."
“I saw that on TikTok.”
Those five words have become an anthem of our times, sparking debates in boardrooms, breakrooms, and hospital corridors.
In an era where nurses and healthcare workers are not just caregivers but content creators, social media has become a double-edged sword—an unfiltered window into the world of healthcare, wielded with equal parts power and peril.
From frontline chronicles during the chaos of COVID-19 to viral dance trends and raw stories of burnout, the rise of “nurse influencers” has given the public unprecedented access to the heart of America’s most trusted profession.
But while this digital shift offers opportunities to amplify nursing’s voice and redefine its narrative, it also raises urgent questions: Is it possible for nurse leaders to regain control of the story when some posts expose cracks in the system? How can hospitals address growing dissatisfaction shared online without alienating their workforce or losing public trust?
With nursing’s reputation as the gold standard of ethics slipping, CNOs must step into a new role: social media strategist. The same platforms that spark division can also inspire collaboration if approached with transparency and purpose.
Nurse leaders who embrace these digital spaces can rebuild bridges, champion their teams, and reframe the conversation. Our CNO editor G Hatfield finds out how.
From payers to patients to policy, revenue cycle leaders need to refine their juggling act and make their voices heard.
As revenue cycle leaders from hospitals and health systems gathered for this year’s Revenue Cycle Exchange happening February 5-7, the atmosphere buzzed with collaboration and strategic dialogue.
With a dynamic agenda designed to tackle the industry's most pressing challenges, the event brought together dozens of revenue cycle leaders to San Antonio, Texas, to exchange ideas, share experiences, and drive innovation in revenue cycle management.
So, what is top of mind for the leaders this year? Look no further than payers, patients, and policy.
How rev cycle leaders are achieving top performance
The first roundtable of the event addressed pivotal questions around payer dynamics, operational alignment, and patient experience.
One major sticking point was learning to adapt to the payer evolution. Leaders anticipate significant shifts in payer behavior (i.e. AI), emphasizing the need for proactive strategies to manage new reimbursement models and policy changes.
When it comes to enhancing patient engagement, rev cycle leaders agree that listening to and resolving patient billing complaints are top priorities, with many organizations implementing patient-centered billing practices to improve satisfaction.
How rev cycle leaders are advocating for policy changes
The attendees agree that now is the time to get involved with legislation.
Case in point was when industry leaders Amanda Bessicks, executive director, government and vendor relations at Baptist Health-Jacksonville, Mike Finley, director of revenue cycle at Emplify Health, and Mike Gottesman, AVP of revenue cycle operations at Northwell Health, provided compelling insights into the intersection of healthcare policy and revenue cycle operations during their panel session.
Bessicks highlighted the operational challenges posed by the No Surprises Act, noting its significant effects on patient payments and billing workflows. Strategies to navigate these hurdles include robust staff training and improved patient communication.
Finley shared experiences advocating for healthcare policy at both state and national levels. He emphasized the importance of engaging not just lawmakers but also with their staff, who often play pivotal roles in shaping policy decisions.
But where do leaders looking to engage in policy discussions start?
Our panel had some ideas:
Start small: Identify local or state-level issues where your input can make an immediate impact.
Build relationships: Hosting lawmakers at healthcare facilities (or going right to the lawmaker’s office) fosters firsthand understanding of operational challenges.
Educate on unintended consequences: Sharing real-world data and patient stories helps policymakers grasp the broader implications of legislation. The key here though, Gottesman says, is to keep your written communications short. Anything longer than one page long is going right in the trash, he says.
As the day concluded, one theme resonated clearly: revenue cycle leaders are not just financial stewards but strategic influencers who play a critical role in shaping healthcare policy, enhancing patient experiences, and driving organizational success.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
As physician salaries soar amid a worsening shortage, healthcare executives are grappling with whether these costs are sustainable or if alternative care team models can ease the financial strain.
Welcome to our HealthLeaders January 2025 cover story. Each month, our editors dive into the topics that matter most—such as healthcare innovation, leadership strategies, payer/provider wars, and patient care—delivered in a dynamic, engaging format.
What did we look at this month? It’s all about physicians.
The escalating costs of employing physicians have become a financial fault line in healthcare. As doctor salaries climb ever higher—driven by an unrelenting physician shortage and skyrocketing demand—healthcare executives are facing a critical dilemma: Are these massive expenditures truly sustainable?
While these high salaries reflect the critical role physicians play in patient care, they also raise difficult questions about sustainability and the viability of other solutions.
Could advanced practice providers, technology-driven efficiencies, or new team-based care models help offset the escalating costs? If not, what's the solution?
This month, our CMO editor Chris Cheney explores the financial and operational dilemmas at the heart of modern healthcare, and the tough decisions leaders must make to balance quality care with fiscal responsibility.
In the high-stakes world of healthcare revenue cycle management, few issues cast as long a shadow as claim denials.
For revenue cycle leaders, the challenge of denials is both urgent and complex, representing a persistent pain point that threatens financial stability, operational efficiency, and patient satisfaction.
Denials are not just a numbers game, and addressing them isn’t merely a matter of firefighting—it’s about building proactive strategies to prevent them from occurring in the first place.
Why Denials Matter
As rev cycle leaders know, denials are a drain on resources. When a claim is denied, it triggers a cascade of consequences: delayed payments, increased administrative workloads, and, in some cases, unrecoverable revenue.
But the cost isn’t just financial.
Denials create friction for patients, who may find themselves navigating confusing bills or facing unexpected out-of-pocket expenses. For care providers, denials can feel like a betrayal of their efforts to deliver high-quality care. Revenue cycle teams often bear the brunt of this frustration, forced into reactive workflows that drain morale and divert attention from higher-value activities.
The urgency to address denials goes beyond operational efficiency; it’s a matter of organizational sustainability. In an era where margins are razor-thin and the push toward value-based care adds layers of complexity, revenue cycle leaders cannot afford to treat denials as a mere operational inconvenience. They are a strategic imperative.
Unpacking the Drama: Why Denials Persist
The root causes of denials are multifaceted, reflecting the intricate web of payer requirements, coding guidelines, and documentation standards that govern healthcare reimbursement. While each denial represents a unique failure point, common culprits include:
Coding Errors: Incorrect or incomplete coding remains a leading cause of denials. Despite advances in technology, human error and gaps in training continue to fuel this issue.
Prior Authorization Problems: Many claims are denied because the required prior authorization was not obtained or was incorrectly documented. The burden of navigating payer-specific requirements falls disproportionately on revenue cycle teams.
Lack of Documentation: Insufficient or inconsistent documentation can leave claims vulnerable to denials, particularly in specialties where clinical nuance matters.
Payer Preferences: Each payer has its own labyrinthine set of rules, and failure to comply with these idiosyncrasies can lead to denials, even when the care provided was medically necessary.
Timely Filing Issues: Missed deadlines for submitting claims or responding to requests for additional information can result in automatic denials, further compounding the issue.
These problems are exacerbated by the lack of visibility into real-time claim status, fragmented communication channels, and siloed data systems.
The result? A reactive posture that keeps revenue cycle leaders perpetually on the back foot.
The Path Forward: Prevention Over Reaction
The key to solving the denial dilemma lies in shifting from a reactive to a proactive approach.
This requires leveraging technology and streamlining processes to anticipate issues before they arise. The good news is that innovative solutions are emerging to help revenue cycle leaders take control.
But how?
For revenue cycle leaders grappling with the high stakes of denials, actionable insights are not a luxury; they are a necessity. That’s why we’re bringing together industry experts for a game-changing webinar designed to tackle this issue head-on.
The next webinar in our Winning Edge series will explore cutting-edge technologies and proven strategies to reduce denials, featuring success stories from leading healthcare organizations.
Our distinguished panel includes:
Beth Carlson, VP of Revenue Cycle at WVU Medicine.
Michael Mercurio, VP of Revenue Cycle Operations at Mass General Brigham.
Eric Sulivant, Solution Strategist at Waystar.
Eric Wicklund, Event moderator and HealthLeaders content manager.
This isn’t just another webinar—it’s your chance to learn from the best in the business and walk away with strategies you can implement immediately.
Join us as we unravel the drama, share solutions, and help you reclaim control over your revenue cycle.
Financial decision-makers are learning that AI will turn revenue cycle management upside down, but it might also save the day.
The promise of AI in healthcare is nothing short of revolutionary, but when it comes to the revenue cycle, the path forward is still challenging.
Revenue cycle leaders are finding that the technology, which expands on automation with generative and predictive capabilities, has been good so far at reducing and improving administrative tasks. But ROI is fleeting, and the true test of AI will come when it’s used to improve payer relations and patient financial engagement.
The 2024 HealthLeaders AI in Finance and Revenue Cycle Mastermind program brought together revenue cycle leaders who are advancing AI in their health systems. Through virtual meetings and an in-person roundtable, the participating executives combined their knowledge and experience to provide a framework from which other health systems might chart their RCM path in the future.
What did we learn? Well, AI in the revenue cycle is a story of slow, gradual improvements and incremental wins. And while the technology has been used to make data-crunching more efficient and ease the workloads of coders and RCM staff, there are still concerns around the unpredictable nature of augmented intelligence, from security concerns to the occasional hallucinations and drift to the ever-present chance of bias.
Those concerns will remain front and center as the technology evolves and the industry learns how to use it.
In this robust report, sponsored by Flywire, we examine how prominent revenue cycle leaders who stand on the brink of advancing AI find themselves caught between the enormous potential for efficiency and cost savings and the perilous task of navigating a labyrinth of challenges.
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This AI in Finance Mastermind series features ideas, solutions, and insights on excelling your AI programs and is sponsored by Flywire.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com
Urged on by COVID-era successes, hundreds of health systems and hospitals across the country are delivering hospital-level care at home. But questions about cost, complexity, and culture are threatening a promising strategy and its 'toxic positivity.' Is it time to abandon ship and return care to the hospital?
Welcome to our December 2024 cover story. Each month, our editors will be taking a deep dive into the topics that matter most to you in our cover story series. From ways to win the payer/provider war to the new era of the APP, we've been working hard this year (and we have even bigger plans for 2025).
What did we look into this month? Hospital at home.
The hospital and the home could not be more different, yet a bold strategy is trying to merge the two. It’s a gamble that could reshape healthcare—or collapse under its own complexity.
The Hospital at Home strategy, borne out of the chaos of the COVID-19 pandemic, was meant to alleviate overcrowded hospitals and offer patients a more comfortable setting to heal. But as it expands, cracks are beginning to show in its ambitious foundation.
On paper, the model combines the best of in-person and virtual care. In practice, it’s a high-stakes balancing act that some argue is teetering dangerously close to failure.
Supporters hail it as a revolution, pointing to studies showing improved outcomes and cost savings. But critics warn of the risks: patients with serious conditions treated far from the safety net of a fully equipped hospital, escalating costs, and a healthcare system strain-ing to adapt.
At a time when more execs are buying in to hospital at home, is it actually time time retreat? Eric Wicklund tries to find out in this month's cover story.
Pictured: Revenue cycle execs talk shop at the 2025 Revenue Cycle Exchange in San Antonio, TX.
