Leveraging Data for Financial Success

Hospitals Turn to RCM Partners for Insights and Advocacy

Daniel Douglas, Vice President of Operations, Hospital Division, Coronis Health

In today’s healthcare landscape, data has become the most powerful asset in securing timely reimbursements and advocating for better policies. Hospitals and clinicians are navigating a challenging environment where delays and denials from payers—particularly insurance plans—are on the rise. How can healthcare providers gain an advantage? By harnessing the power of data through their revenue cycle management (RCM) partners, facilities can identify roadblocks, hold payers accountable and drive meaningful change.

Data: The Key to Overcoming Denials and Delays

The increasing difficulty in securing payment for medical services, whether from patients or insurance plans, has put significant pressure on hospitals. Recent studies show that initial denial rates have risen from 10.15 percent in 2020 to 11.2 percent in 2022, with another jump to 11.99 percent in 2023. This upward trend highlights a growing challenge. However, there is hope—new technology and data analytics are enabling hospitals to pinpoint exactly where delays occur and which payers are most resistant to fulfilling their obligations.

By tapping into these insights, hospital leaders are gaining the tools needed to advocate for systemic change. Access to comprehensive data has proven pivotal in engaging policymakers on critical issues like payment denials. With hard evidence illustrating the growing challenges posed by payer denials, healthcare advocates are driving meaningful discussions in policy circles, leading to a notable shift in attention and action at the legislative level.

Turning Data into Action: Driving Policy Change

Organizations such as the American Hospital Association (AHA) and the Federation for American Hospitals (FAH) have been leveraging this data to petition for reforms, to include the realm of Medicare Advantage (MA) denials. Armed with evidence from national studies and reports, hospital lobbyists are making the case that the surge in denials stems more from payer policies than from hospitals’ pricing practices. This data has also proven valuable in highlighting the financial burden faced by hospitals due to uncompensated care and claims denials.

Data has played a pivotal role in spotlighting the critical challenges hospitals face. For example, following a major cyberattack on a key vendor, hospitals were able to leverage comprehensive data to quantify the widespread disruption to healthcare services. This hard evidence proved essential in capturing government attention and driving action, highlighting the real-world impact on patient care and operational efficiency.

Bridging the Data Gaps: The Next Frontier

Despite the benefits that data-driven insights bring, there are still critical gaps that need to be addressed. For example, many current RCM platforms rely on submitted claims data, which doesn’t fully capture cases where care was never delivered due to payer policies. Concurrent denials—those that happen while a patient is still receiving care—are also not always included in the analytics, further complicating the process of holding payers accountable.

In addition, the burden of prior authorization requests and concurrent reviews remains a pressing issue for hospitals. These processes create administrative delays and add to the overall strain on healthcare systems. By collecting quantitative data on these burdens, hospitals can more effectively demonstrate the regulatory cost associated with navigating payer policies and advocate for reforms that streamline care delivery.

Empowering Change Through Data-Driven Advocacy

In the battle for timely reimbursements and fair payer practices, hospitals are increasingly looking to their RCM partners for data that not only supports their financial operations but also strengthens their policy advocacy efforts. The growing denial rates are a wake-up call, and access to real-time, actionable data is proving to be the game-changer in making the case for change at both the operational and legislative levels. As more hospitals adopt advanced RCM tools, they are better equipped to navigate the complexities of payer negotiations and influence policy discussions in Washington D.C.

The future of healthcare reimbursement lies in data-driven advocacy. By partnering with forward-thinking RCM providers, hospitals can ensure that they have the facts on their side—ultimately leading to a more equitable healthcare system for providers and patients alike.