From Reactive to Resilient: Using Technology to Stop Revenue Leakage

Uncover the real costs of in-house medical billing and learn how identifying hidden expenses can help protect your revenue, improve efficiency, and support long-term financial stability.

 

Managing revenue in today’s healthcare environment can often feel like trying to fill a leaky bucket—despite continuous effort, valuable resources keep slipping away. With declining reimbursements, increasing administrative demands, and constant pressure to maintain financial stability, many healthcare organizations find it increasingly difficult to sustain a strong revenue stream.

The good news is that technology is no longer just a background player—it’s quickly becoming the foundation for smarter billing and collections. Instead of constantly reacting to challenges, healthcare organizations now have the opportunity to get ahead of the curve.

For finance professionals steering healthcare organizations, the real game-changer lies in automation, predictive analytics, and streamlined systems. These tools don’t just patch holes; they prevent leaks before they start—stopping claim denials and underpayments in their tracks.  The payoff? A stronger, more resilient financial future that’s built on proactive strategy, not reactive scrambling. 

The BHS team is the outsourced release of information partners for many healthcare organizations and we see a number of examples of facilities using technology to reshape revenue cycle management. Below we share a handful of the top practical strategies to help minimize financial loss while unlocking your practice’s full revenue potential.

The Digital Shift—How Technology Is Reshaping Medical Billing and Collections

Healthcare finance is in the midst of a digital transformation, streamlining once-tedious tasks and reducing the chance of costly human errors. The result? A smarter, faster, and more reliable approach to managing billing and collections. 

At the forefront of this shift is automation. Imagine claim submissions, payment postings, and patient billing handled with pinpoint accuracy—no more chasing down errors that slow your revenue flow. According to McKinsey’s article, Setting the Revenue Cycle Up For Success in Automation and AI, effectively deploying automation and analytics alone could eliminate $200 to $360 billion of administrative costs in the US healthcare system. Automation doesn’t just save time and money; it builds a system that works efficiently behind the scenes.

Then there’s artificial intelligence, a tool that should help us not simply react but predict. AI can be used to dig through mountains of data to spot patterns in denials and underpayments. It’s like having a financial detective on your team, identifying trouble spots before they become costly setbacks.

Real-time eligibility verification tools take it a step further by confirming patient coverage before services are provided. This proactive approach reduces administrative headaches and cuts down on claim denials tied to eligibility issues.

In short, these innovations aren’t just upgrades—they’re reshaping the future of revenue management, making every process smarter and every dollar easier to secure.

Common Pitfalls—The Cost of Claim Denials and Underpayments

Returning to the leaky bucket analogy, claim denials and underpayments represent significant sources of revenue loss—small but persistent leaks that can drain financial performance over time. At first, they might seem minor—just a trickle here and there. But over time, those small losses can add up, weakening the vessel’s ability to stay afloat. For healthcare organizations, these financial drips can quietly chip away at revenue integrity, turning manageable issues into serious threats.

Every denied claim isn’t just a delay—it’s a red flag signaling potential revenue loss. Left unchecked, these setbacks can erode financial stability, making it harder for healthcare organizations to thrive. The challenge isn’t just fixing the leaks—it’s finding and sealing them before they drain resources. 

More leaks in the bucket can include:

1. Bundling – Rather than paying fees for two separate services, the payer groups them together and pays one, smaller fee.
2. Services already included in payment of another service or procedure – This happens when payment is adjusted because the benefit for the service is included in the payment or allowance for another service or procedure that has already been adjudicated.
3. Exceeded timely filing limit – This happens when claims are filed outside the payer’s required days of service; this should be factored into the time it takes to rework rejected claims.

The Journal of AHIMA has created a more comprehensive list of common reasons claims get kicked back, you can read it here. 

These challenges run deeper than lost revenue. They ripple through every layer of an organization, driving up administrative costs, creating operational bottlenecks, and pushing staff closer to burnout. Each denied claim doesn’t just stall payment—it demands time, energy, and resources to resolve, pulling focus away from patient care and financial strategy.

Industry reports paint a stark picture: healthcare providers spend millions every year just to address claim denials. It’s not just a financial drain—it’s a productivity trap that burdens staff and strains operations, making it harder for healthcare organizations to run efficiently and maintain financial health.

Best Practices for Preventing Claim Denials

Staying ahead of claim denials isn’t about playing defense—it’s about stepping up with a proactive game plan that protects revenue before issues arise. One of the strongest moves any practice can make? Investing in continuous staff education.

In an industry where coding standards and payer requirements shift like moving targets, ongoing training isn’t optional—it’s essential. Regular updates on CPT, ICD-10, and HCPCS code changes are just the beginning. Billing teams also need to stay sharp on payer-specific requirements, documentation guidelines, and medical necessity criteria. Advanced training programs help your team stay agile and ready to handle complex demands, keeping compliance strong and revenue loss in check.

But education is just one piece of the puzzle. Predictive analytics is reshaping revenue cycle management by turning hindsight into foresight. By analyzing historical claims data through machine learning, healthcare organizations can spot patterns behind recurring denials and underpayments. With this knowledge, finance leaders can target specific issues—tightening documentation, refining coding accuracy, or fine-tuning payer-specific workflows. Predictive tools can even flag high-risk claims before submission, giving staff a chance to correct errors early and boost first-pass acceptance rates. Leading vendors offering these predictive tools include Waystar, Optum, and Experian Health—all recognized for their advanced analytics platforms that help practices improve clean claim rates and minimize preventable denials.

Another powerful strategy? Automating pre-authorizations and patient eligibility verification. Integrated tools within electronic health record (EHR) systems confirm coverage in real time, highlight policy limitations, and ensure necessary authorizations are secured before care begins. This not only streamlines front-end operations but also slashes the risk of eligibility-related denials. Plus, by embedding these checks into daily workflows, healthcare organizations can offer patients clear, upfront cost estimates—enhancing satisfaction and building trust through financial transparency.

Together, these strategies form a solid foundation for denial management. They don’t just safeguard revenue—they create a smarter, more sustainable financial future for healthcare organizations.

Strategies for Minimizing Underpayments

Underpayments often fly under the radar, yet they can be just as damaging as claim denials over time. Without strong tracking systems, these quiet revenue leaks can slip by unnoticed, slowly eroding your practice’s financial health.

Here are some practical strategies we’ve seen used by leading organizations to help mitigate underpayments:

• Regular contract reviews: Ensure that payer contracts are up-to-date and reflect fair reimbursement rates. Renegotiating terms can uncover opportunities for improved payment rates.
• Automated tracking systems: Implement technology that flags discrepancies between billed amounts and payments received, allowing your team to address shortfalls promptly.
• Appeal processes: Develop a streamlined system for managing appeals on underpaid claims, ensuring that no revenue opportunity is left unclaimed.

Technology Integration—What to Look for in Billing Solutions

Selecting the right technology is key to unlocking the full potential of your revenue cycle management. The right tools don’t just streamline processes—they empower your team to work smarter, reduce errors, and keep revenue flowing smoothly. We’ve seen successful finance leaders prioritize tools that offer:

• Automation: : Manual processes are time-consuming and prone to errors. Modern systems automate claim submissions, payment processing, and patient communications, reducing administrative burden and accelerating reimbursements. Automated workflows also ensure timely follow-ups on outstanding balances, minimizing revenue leakage.
• Predictive analytics: Data-driven insights are a game-changer. Advanced analytics tools can flag high-risk claims before submission, allowing for proactive corrections that increase the likelihood of acceptance. Predictive modeling also helps organizations anticipate cash flow trends, manage denials more effectively, and identify operational bottlenecks that impact revenue.
• Comprehensive reporting: Financial leaders need more than just raw data—they need actionable insights. Real-time dashboards and reporting tools provide a clear picture of revenue cycle health, enabling better forecasting, performance tracking, and strategic decision-making. The ability to drill down into specific metrics, from denial rates to payer reimbursement trends, ensures continuous improvement and financial stability.

Interoperability is another crucial factor. Your billing solution should connect with other systems, especially your electronic health records (EHRs) and patient management platforms. When systems work together, data flows smoothly, reducing administrative headaches and making the entire process more efficient.

Top healthcare facilities know that the right billing solutions can make all the difference when it comes to efficiency and smooth operations. The Mayo Clinic uses Epic resolute for its EHR and billing solutions. Epic Resolute is the billing and revenue cycle management (RCM) system within the Epic software suite. It helps healthcare organizations manage the money side of patient care — everything from sending bills to patients and insurance companies to processing payments and handling claims.

Similarly, Ascension Health and Bon Secours use the Revenue Cycle suite by MEDITECH for their EHR and robust billing solutions. MEDITECH offers comprehensive billing solutions as part of its Revenue Cycle suite, designed to streamline financial operations for healthcare organizations. Their integrated system supports revenue generation by providing efficient tools that enhance both staff workflows and patient experiences.

These platforms aren’t just about processing payments—they’re designed to integrate effortlessly with larger healthcare systems. The result? Smoother workflows, fewer administrative headaches, and stronger revenue cycle management that supports both financial health and patient care.

The Human Element—Why Technology Works Best with Skilled Professionals

Technology has the power to transform billing and collections, but its true potential is only realized when it works hand-in-hand with skilled professionals. No system—no matter how advanced—can yet match the intuition, critical thinking, and experience that human experts bring to the table. Navigating the gray areas of healthcare finance often requires judgment calls, creative problem-solving, and negotiation skills that technology can support, but not replace.

Think of technology as an amplifier for human expertise. Automated tools are excellent at handling the repetitive, time-consuming tasks—claims processing, payment posting, and data entry—that can bog down teams. By taking those burdens off their plate, technology frees staff to focus on what they do best: strategic financial planning, digging deep into denial analysis, and refining payer negotiations. The result isn’t just improved revenue cycle performance—it’s higher job satisfaction as employees engage in work that challenges and inspires them.

Leadership plays a vital role in striking the right balance between technology and human skill. Forward-thinking leaders cultivate a culture of continuous learning, encouraging staff to embrace new technologies while sharpening their expertise. Regular training sessions, workshops, and access to the latest industry resources help keep teams sharp and prepared for changes in regulations or advancements in technology. Rolling out a tech solution without first understanding the business processes behind it—without having the people in place to understand it—is a recipe for frustration and even disaster.  For more on the basics of putting a “People First” process in place, check out this Forbes article. Lastly, keep in mind that open communication between leadership and billing teams is an essential ingredient for spotting workflow gaps, sharing insights, and driving innovation.

Beyond operations, human expertise is crucial for making sense of the data that technology generates. Predictive analytics might highlight patterns or flag potential issues, but it takes a skilled professional to turn those insights into meaningful action. Financial leaders who can translate data into real-world strategies—whether it’s renegotiating payer contracts, streamlining billing processes, or refining patient payment systems—will see the greatest return on their technology investments.

In the end, the strongest revenue cycle strategies are built on a partnership between technology and human expertise. Technology brings speed, accuracy, and scalability. People bring strategy, creativity, and judgment. When these forces work together, healthcare organizations can stay financially resilient and ready to adapt to the ever-changing demands of healthcare finance.

Final Thoughts

Technology is transforming medical billing and collections, opening doors for healthcare organizations to protect revenue streams and strengthen financial health. With the right tools, organizations can minimize claim denials, prevent underpayments, and streamline operations—all while saving time and resources.

But technology on its own isn’t the answer. The real power lies in pairing innovation with skilled professionals who know how to use these tools to their full potential. This blend of cutting-edge technology and human expertise creates a resilient, future-ready revenue cycle—one that not only weathers financial pressures but also sets the stage for sustainable growth.

While BHS Connect does not provide billing software or revenue cycle systems, we just wanted to highlight the benefits of working with companies that do. At BHS Connect, our expertise is in Release of Information services. If you would like to learn more about how BHS helps healthcare organizations with Release of Information, we would love to connect.