With so many changes in healthcare revenue cycle management (RCM), one thing remains constant: the challenge of claim denials. As we move into 2025, RCM executives face unprecedented challenges in managing and preventing denials, but they also have access to powerful new tools, strategies, and services to combat them. Understanding these challenges and opportunities is imperative for maintaining financial stability in today’s healthcare environment.
The New Normal: Denials Aren’t Going Anywhere
The statistics are sobering. The American Medical Association reports that denial rates jumped to 11% in 2023, up from 8% just two years prior. For an average health system, this translates to approximately 110,000 unpaid claims—a financial burden that no healthcare organization can afford to ignore.
According to Deloitte’s 2025 US Healthcare Outlook, 60 percent of payer respondents anticipate the adoption of digital technology to accelerate in 2025. Moreover, 58% of payer executives identified artificial intelligence (AI) and automation as the emerging trends they are tracking. According to Deloitte, many payers are already using gen AI in areas like claims processing, underwriting, personalized treatment plans, fraud detection, and document extraction.
This trend shows no signs of slowing down, making it clear that denials management isn’t just a temporary challenge—it’s the new normal in healthcare finance.
What’s driving this surge in denials? It’s a perfect storm of factors:
- Increasingly complex billing codes and documentation requirements
- Shifting payer policies and regulations
- The widespread adoption by payers of AI-boosted denials systems
- Staffing shortages in revenue cycle departments
The message is clear: RCM executives need to develop comprehensive, sustainable strategies to address denials if they want their organizations to remain financially viable. Standing still is not an option.
Artificial Intelligence: Your Ally in the Fight Against Denials
Here’s a reality check: payers are already using AI-powered algorithms to process and deny claims at unprecedented speeds. This isn’t speculation—it’s happening right now, and hospitals and healthcare systems that haven’t adopted AI technologies to combat these automated denials are already playing catch-up.
The good news? AI can be a game-changing ally in your denials management strategy. According to a Deloitte workforce technology study, gen AI and automation technologies can slash by half the amount of time revenue-cycle staff spend on routine tasks and allow bedside nurses 20% more time to spend on direct patient care.
While healthcare systems have traditionally trailed other sectors in technology adoption, they’re shifting priorities for 2025. Per the Deloitte 2025 outlook, 43% of health system executives mentioned investing in core business technology solutions and a notable 30% of them plan to invest in digital technology platforms to strengthen their core operations.
Modern AI services bring unprecedented capabilities to healthcare organizations, transforming how they handle the entire revenue cycle process. These platforms can analyze vast amounts of data in real-time, identifying patterns and potential issues before they result in denials.
Key AI capabilities in denials management include:
- Proactive identification of potential denials before claims submission through pattern recognition and predictive analytics
- Automated extraction and analysis of essential data from complex medical records
- Generation of sophisticated appeals with supporting clinical documentation
- Real-time prediction of denial trends to enable proactive operational adjustments
Not All Denials Are Created Equal
One of the most critical insights for RCM executives is understanding that different types of denials require different approaches and expertise. Technical denials, clinical denials, DRG downgrades, and underpayments each present unique challenges and require specialized knowledge and tools to address effectively.
Success in modern denials management requires a sophisticated, multi-layered approach that combines the right people, processes, and technology. This includes:
Specialized knowledge across denial types, such as:
- Clinical specialists for medical necessity denials
- Coding experts for DRG and technical denials
- Revenue integrity teams for underpayment recovery
- Legal expertise for complex appeals
And advanced AI-accelerated technology services that enable:
- Automated workflow routing based on denial type
- Real-time monitoring of denial patterns and trends
- Integration with existing EHR and billing systems
- Advanced analytics for strategic decision-making
The Power of Partnership
Trying to build and maintain all the necessary denials-management capabilities in-house can be overwhelming. The right vendor partner can provide both the technological infrastructure and the specialized knowledge needed to level the playing field with payers.
A strategic partner should bring comprehensive capabilities that include advanced AI and automation technologies, deep expertise across all denial types, proven track records of successful appeals, and continuous innovation to stay ahead of payer strategies. Perhaps most importantly, they should seamlessly integrate with existing workflows and systems, enhancing rather than disrupting current operations.
Looking Ahead
As we progress through 2025, the healthcare organizations that will thrive are those that embrace change and innovation in their denials management strategies. Success requires a multi-faceted approach that combines cutting-edge technology, specialized expertise, and strategic partnerships.
For RCM executives, the path forward is clear: invest in AI-powered services, build specialized teams, and partner with experienced vendors who can help navigate and avoid potential pitfalls. The time to act is now—before the gap between payer capabilities and provider resources becomes insurmountable. Remember: standing still means falling behind.
RCM executives: Are you ready to finally level the playing field with payers who have a financial and technological head start? A partnership with Aspirion includes taking advantage of our pioneering, AI-powered RCM platform, along with our expansive and experienced team of data scientists, legal experts, and clinicians. We do the heavy lifting, so you don’t have to. Let us boost your revenue recovery fast and efficiently. Contact us today!
