Perspectives on AI, Denial Prevention, Revenue Cycle | Sift Healthcare
Sift Perspectives
AI in the Revenue Cycle: A Priority, But…
AI in the revenue cycle isn’t at a tipping point; it’s a sticking point. Revenue cycle leaders at health systems across the country are being given AI mandates. At Sift, we’ve heard from multiple revenue cycle leaders that their CEOs...
5 Levels of Denial Reporting — And Why Most Health Systems Stop at 3
Your EHR denial reporting probably answers these questions well: How many accounts did each rep touch? Which queues are aging? What’s your denial rate by payer? Those are legitimate operational questions. But they’re activity questions, and activity isn’t outcome. The...
Payments Intelligence Impact Point: $13M Recovered From $43M in Aged Denials.
A large regional health system had a problem familiar to most revenue cycle leaders, a sizable book of denied, aged accounts that their internal prioritization logic had effectively written off. These accounts were buried under a rules-based workqueue that couldn’t...
CEO Perspectives: Why the Revenue Cycle Industry Isn’t Designed to Fix the Revenue Cycle
Denials are unequivocally one of the biggest problems for US health systems. But across the revenue cycle industry, most technology companies and outsourcing firms are not economically incentivized to solve the denial problem. They’re incentivized to make it manageable. The...
EHR Denials Management Limitations
Your EHR vendor probably told you it covers denials management, maybe even using AI. In a narrow sense, it does. EHRs capture and queue denials, and, if you’ve got the right module configured and an analyst who knows how to build the reports, it’ll show you denial trends by payer. But what EHR denials management tools won’t...
6 Things Aetna’s SOI Policy Is Breaking In Your Revenue Cycle
Last month, we wrote about the updated Aetna Medicare SOI policy and what it means for inpatient reimbursement. Since then, we’ve been watching how this plays out operationally, and the picture is more complicated than the policy summary suggested. What...
How to Know if a Denial Cluster is Worth Automating with an AI Agent
Agentic AI is being hailed across the revenue cycle right now, for appeals, claim resubmissions, documentation retrieval and a slew of other workflows. For the most part, the use cases make sense on paper. But many health system revenue cycle teams are making deployment decisions based on...
CEO Perspectives: Health Systems Are Wrong About Their Denial Rates
I don’t mean that to be provocative, I mean it literally. The number any given hospital revenue cycle team reports as its denial rate is almost certainly not its denial rate. Upstream Revenue Loss Most health systems measure denials through...
Score First, Outsource Second: Why A/R Scoring is the Smarter Path to RCM Vendor ROI
Dollar value and recovery probability are not the same thing. Health systems that outsource without scoring first are paying contingency fees on claims they could have kept. For most health systems, accounts receivable outsourcing feels like a necessary hedge against...
Segment Loop 2110: Another Way Your 835 Isn’t Showing Your Denials
The Loop 2110 segment was designed to communicate payer decisions. But payers have moved on, and health systems still managing denials through the remittance file are working with an incomplete picture. We’ve seen an influx of Google searches for “835...