The Denials Dilemma & Untangling the Payer Currents

How to navigate payer complexity to reclaim control over denials, compliance & cash flow

Denials have become a defining challenge of modern healthcare finance by being a turbulent current pulling health systems off course. In 2022 alone, U.S. hospitals and health systems spent an estimated $19.7 billion battling payer denials, according to American Hospital Association (AHA). More than half of those denied claims were ultimately overturned, equating to roughly $11 billion in administrative effort spent arguing for payment, that should have flowed smoothly through on the first pass.

For healthcare CFOs, the denial dilemma is a performance-stalling headwind that slows cash flow, increases operational fatigue, and threatens financial stability.

Understanding the Payer Currents

A Sea of Constantly Shifting Requirements

Today’s payer landscape resembles a channel with shifting sandbars: difficult to navigate, ever-changing, and occasionally opaque. Contract intricacies, evolving authorization rules, and new reimbursement models create unpredictable currents that revenue cycle teams must continuously adapt to.

According to the AHA’s 2022 and 2024 reports, denials have risen sharply, evidenced by denials increasing 20.2% for commercial claims and 55.7% for Medicare Advantage claims between 2022 and 2023. Challenges include retroactive denials, inconsistent application of medical necessity criteria, and approvals being reversed despite valid prior authorization.

These unpredictable currents will ripple downstream quickly, when payer rules shift without warning. Billing, coding, and pre-bill teams are left chasing compliance, often blindly without the analytics or visibility to steer ahead of emerging risks.

The result: stalled cash collections, heavier rework, and more claims drifting into costly appeal cycles.

From Denial Management to Denial Prevention for Navigating Ahead of the Storm

The most effective CFOs aren’t endlessly bailing water when it comes to denial management. Rather, they’re adjusting the sails of revenue cycle management as a whole to drive sustainable performance from their revenue cycle. The shift from reactive denial management to proactive denial prevention marks a fundamental transformation in how organizations maintain revenue integrity confidently.

1. Root-Cause Analytics as Your Navigational Chart

Without clear visibility into why denials occur, teams are left navigating in the fog. Scalable denial prevention begins with uncovering patterns across payer types, service lines, encounter types, and denial reasons.

Data-driven insights serve as a navigational chart, helping leaders anticipate obstacles before they disrupt revenue flow.

2. Intelligent Workflows that Catch Trouble Before It Breaks the Surface

Automated workflows act like an early-warning system by flagging high-risk claims before they hit payer shores. Whether that’s validating authorization requirements, enforcing coding specificity, or applying payer-rule logic, automation ensures the right checks happen at the right time.

This proactive model reduces rework, improves first-pass yield, and prevents claims from drifting into denial territory.

3. Process-Level Interventions that Steer the Entire Crew

Denial prevention is a woven technical, cultural, and operational shift. Effective organizations must align front-end, mid-cycle, and back-end teams around payer intelligence, ensuring the full RCM crew rows in rhythm:

• • Scheduling and authorization teams aligned with payer criteria
  • Billers reviewing high-risk claims before submission
  • Leaders monitoring payer behaviors & root cause trends

Currance supports this shift by providing the analytics, automation, and workflow intelligence needed to steer revenue cycles away from preventable denials and toward smoother reimbursement waters.

Administrative Efficiency is Financial Resilience

Reducing administrative burden isn’t just about smoothing the day-to-day. It’s about building a sustainable, more resilient revenue cycle that built to weather industry volatility by:

• Reclaiming Time and Productivity: Every denial avoided is time returned to teams that can be reallocated toward complex cases, payer negotiation, or strategic revenue initiatives.
• Accelerating Cash Flow and Stabilizing Margins: A healthier first-pass yield means faster payments and more predictable revenue. And in an environment where margins remain thin, predictability is power.
• Reducing Compliance and Audit Risks: Prevention-based processes support cleaner claims, reduce compliance exposure, and minimize the costly ripple effects tied to payer disputes or audit findings.

The AHA’s 2024 administrative burden report underscores how insurer requirements have ballooned, forcing hospitals to devote significant staff and clinical hours to chase correct payment. By automating prevention, organizations reduce friction, reclaim resources, and create financial breathing room.

When CFOs streamline payer interactions, reduce manual rework, and reinforce processes with automation, the revenue cycle becomes more seaworthy with the ability to navigate complexity without losing speed or direction.

Key Takeaway: Prevention Is the Strongest Rudder

Denials aren’t just paperwork or nuisance. They’re a symptom — a signal that solutions in place upstream needs recalibration.

A prevention-first approach strengthens the entire revenue engine by:

⚓ Providing data-driven visibility into where denials originate
⚓ Automating workflows that catch high-risk claims early
⚓ Embedding payer intelligence across teams for consistent, system-wide accuracy
⚓ Returning focus to high-value strategic work instead of manual rework
⚓ Stabilizing cash flow and enabling stronger financial navigation

With the right analytics, automation, and operational alignment, CFOs can untangle even the most challenging payer currents. The organizations best positioned for long-term success aren’t the ones managing denials more efficiently — they’re the ones preventing denials entirely.

With a trusted partner like Currance guiding the way, healthcare leaders can regain control of their revenue cycle, steady the ship, and chart a more resilient financial course forward. If you are ready to transform revenue cycle differently, contact us to get started on a path to sustainable RCM performance.