Hospital Revenue Cycle Leaders Describe Tactics to Counter Payer Denials
In a Becker's Hospital Review series, hospital and health system revenue cycle executives describe how payer behavior has shifted over the past year and how their teams responded. Executives from Access Medical Clinic, Thorek Memorial Hospital and UC Davis Health cite increased prepayment medical record reviews, outsourced utilization review vendors with shifting authorization criteria, and more aggressive medical necessity challenges even after prior authorization was secured. Responses included negotiating directly with payers using sample documentation to remove blanket claim edits, building CPT-code-specific authorization tracking work queues, and integrating utilization management and clinical teams to strengthen documentation before claims submission. The piece is a recurring Q&A series soliciting further reader responses on payer-related operational challenges.