Can You Squeeze More Out of Your Revenue Cycle? Here’s Where to Look

Rising denial rates, payer complexity and labor/technology constraints are squeezing providers from every angle. But with a smarter A/R strategy—and the right tech— you can take back control.

Across the field, one thing has become inescapable: providers are simply not being reimbursed fairly for the care they deliver. As margins shrink and payer complexity grows, leaders are digging deeper to reclaim and maximize revenue they’ve already earned. But the space to squeeze is getting ever smaller.

Denial rates are climbing steadily, with recent data from the Kaiser Family Foundation showing that insurers denied 19% of in-network claims. That’s an enormous drag not just on bottom lines, but also on patient care, because each denied claim is a disruption. Meanwhile, the Centers for Medicare & Medicaid Services set the 2025 Medicare Outpatient Prospective Payment System (OPPS) payment update at 2.9%, far behind inflation and cost growth. Compounding an already challenging situation, payer delays and denials are becoming the new normal.

Headwinds: Labor + Tech + Payer Behavior

Today’s revenue-cycle leaders are battling a perfect storm of operational constraints and external pressure.

Labor issues are at the forefront. Recruiting, training, retaining, and continuously managing an A/R workforce with the right mix of skill, tenacity and payoff is harder than ever, and rising labor costs only widen the gap. With provider margin shrinking, competing with private sector wages is nearly impossible.

On the technology side, most revenue cycle systems, mainly EHRs, were never built for this level of complexity. They struggle to deliver the productivity, visibility, and reimbursement logic that follow-up demands. Too many organizations are still managing A/R manually and via generic work queues, with no prioritization, minimal insight, and old‐school workflows. This is why the shift toward autonomous insurance management is becoming essential. Emerging platforms are designed to not just support staff but to perform tasks so teams can focus on exceptions rather than on everything, missing critical claims along the way.

Then there’s payer behavior—arguably the wildcard. Insurers are deploying their own AI, automation, and tactics to accelerate denial or payment delay, shifting risk and burden back to the provider. When you compound labor scarcity and legacy tech, you get a revenue-cycle machine that’s reactive, not strategic.

The Manual Reality of Insurance Follow-Up

Let’s get specific: the heart of the revenue leakage problem is often one thing—manual insurance follow-up. Despite the evolution of revenue cycle tech, this process continues to be poorly addressed.

Most tech platforms still route A/R follow-up through auto-generated work lists, with no prioritization logic, no smart triage, and precious little visibility. A/R reps are left to decide which claims to work and how, often navigating a maze of disparate portals, adjudication rules, payer policies, outdated information, and shifting expectations.

There is no standard workflow, virtually no quality control or enforcement built into the rep’s daily process, and extremely limited ability to measure performance or outcomes. The result is decentralized, inconsistent, unmeasured effort with unpredictable results.

And yes, the payer role matters here. The follow-up process for payers is a constantly shifting landscape. They expand documentation requirements, delay responses and change portals. At scale, it becomes a strategic lever for them, and a reactive nightmare for the provider.

Thus, many health systems find that their revenue cycle strength is in direct proportion to the strength of their leadership. But leadership needs the right tools. You need visibility, logic, workflow, and enforceability.

Where Revenue Cycle Leaders Should Focus

Because every dollar recovered strengthens your margin, the stakes have never been higher. If you’re looking to squeeze more from your revenue cycle, start by focusing on three pivotal areas: performance management, A/R strategy, and workflow.

Performance Management. You need solid, real-time insight into what’s happening in your A/R. Which claims are stuck, why they’re stuck, which reps are performing, and what actions lead to recoveries. Without a system that surfaces these points, your A/R is flying blind.

A/R Strategy. Insight without action is wasted. Once you know your problem areas, you need a coherent game plan: which claim buckets to prioritize, which processes to reform, which reps to focus on, and when to escalate. That plan must be data-driven, not guesswork.

A/R Workflow. Strategy only works if it is consistently followed. That means embedding decision logic, enforcing best practices, building accountability, and measuring results. A good workflow generates prescriptive guidance, drives adherence, and enables continuous improvement.

When performance, strategy, and workflow align, you turn insurance follow-up into a proactive margin recovery engine.

How Intelligent Automation Changes the Game

Let’s talk tech and automation—because the right platform is what allows you to implement and scale these three elements. A truly modern revenue cycle platform should deliver four things:

• Pinpoint the problem. Through robust analytics, you should be able to identify precisely where claims get stuck, why they’re stuck, and what it will take to move them forward.
• Enable strategy. With that insight, you build direction: what to focus on, what to escalate, and how to allocate your workforce.
• Enforce execution. Workflow tools must translate strategy into actionable steps: triage logic, prioritization, decision support, and performance feedback. Increasingly, these steps should not rely on people. This is where automation and autonomous follow-up matter. Routine tasks, predictable outreach and repeatable next steps should be executed by the platform, not a person, so teams can focus on exceptions.
• Delight users. If reps don’t adopt the system, it fails. User experience matters—intuitive, efficient, aligned with how reps actually work.

Specifically, one powerful model to consider is a PSR classification: Phase–Status–Reason.

• Phase tells you where the claim is in its lifecycle.
• Status reveals its current condition (pending, under review, denied).
• Reason explains why it’s in that status.

That “why” is everything. When your RCM team understands why insurance A/R exists, they can take direct, informed action instead of relying on guesswork. That’s the difference between chasing dollars and reclaiming them.

The Bottom Line

You can’t change payer behavior. You can’t alter Medicare reimbursement or stop payer delays. What you can do is capture every dollar you’re owed with greater efficiency and intelligence.

In today’s margin-compressed, cost-intensive environment, every improvement in your revenue cycle directly impacts operating income. That means the difference between staying afloat and thriving could be as simple as collecting what you’ve already earned.

So, ask the right question, not just “How much more can we collect?” but “How intelligently are we collecting it?” And build your approach around performance, strategy, and workflow—with the right technology at the heart.