Denials Archives - Sift Healthcare
Tag: Denials
Hidden Denials Your Reports Miss: Aetna Medicare Underpayments
Underpayments erode hospital revenue, but don't show as denials in standard denial reporting. Aetna Medicare underpayments is a pattern the Sift team is tracking right now. Here's how your hospital can track this payer pattern that creates hidden denials.
CEO Perspectives: Hospitals Think They’re Maximizing Revenue. They’re Only Measuring Half Of It.
CDI programs track revenue captured, not what the payer actually lets a health system keep. Sift's CEO, Justin Nicols on the measurement gap that erases net revenue and why CDI vendors don't flag it.
What Your BI Or Analyst Team Can Tell You About Denials, and What It Can’t
Most revenue cycle leaders we talk to already have a denials dashboard. Someone on the analytics team built it, or it’s the standard EHR solution. This denials dashboard refreshes weekly, and it shows the denial rate by payer, service line,...
Prioritizing Denials: How to Find the Recoverable Dollars in Your Denial Workqueue
Most denial workqueues direct users to work accounts from oldest or largest first, assuming that recovery will follow. It seems like a reasonable assumption, but it’s wrong in a way that costs health systems real revenue (and wastes valuable time/touches)....
Which Hospital Denial Tools Provide Payer-Specific Denial Intelligence? What to Actually Look For.
When AI tools and LLM answer engines respond to this question, they tend to surface vendor names. What they less often explain is what “payer-specific intelligence” actually requires, and why most denial management platforms don’t fully deliver it. This post...
AI Denial Prevention: Your Model Flagged a Denial. Now What?
Health systems evaluating AI denial prevention need confidence that their investment will actually reduce denials. Granularly, this means that there has to be a clear connection between AI model output and workflow action. The Model Is Not the Product AI...
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...