Denials and underpayments are another critical pain point, and in today’s adversarial economy they’re actually increasing. Again, participants spoke of the need to assess individual payer trends and tendencies to understand when denials and underpayments occur, and even anticipate them before they happen.

As with prior authorizations, savvy RCM leaders can use AI to develop clinical protocols that avoid denials when possible, teaching clinicians what to look out for when they create their care plans. They can also use AI tools to gather data necessary to refute denials and underpayments, and draft responses to payers.

The administrative burden associated management associated with denial management and utilization review remains a pain point for revenue cycle leaders. While AI has the potential to remove these burdens, payer practices often prevent health systems from realizing relief. 

When a health system implements a solution to automate aspects of the PA process, for instance, payers may implement their own technology or update their policies to render the solution obsolete or to erase efficiency gains for the health system. 

“I think that in a few years it's going to be AI against AI,” says Christina Slemp, MHA, MSHI, System VP of Revenue Cycle at UNC Health. “Do we just let the AI fight it out and figure out what's there?" 

Payers have recently indicated an openness to increased collaboration with providers. In June 2025, more than 40 payers announced their intention to limit and simplify PA processes, and to develop standardized data transmission requirements. However, revenue cycle leaders remain skeptical. 

“I would say I’m hopeful, but not optimistic about what we’ll really get from this and what they’ll commit to,” said Beth Carlson, Chief Revenue Cycle Officer at WVU Medicine.  

One of the more intriguing results of AI integration in the RCM space, according to Mastermind participants, is the potential to bring RCM to the C-Suite table. The ROI seen in AI implementation so far has raised the visibility of RCM operations, giving leaders an opportunity to collaborate with the CIO, CMO, CNO and others. 

It’s important for RCM leaders to seize this opportunity. Engaging with clinical leaders offers the chance to create clinical pathways and programs that not only meet clinical goals, but enhance coding and reimbursement opportunities. Programs with dual RCM and clinical ROI stand a much better chance of gaining CEO and CFO approval, not to mention better outcomes.

“That’s how you get friends,” Ansley noted.

Bolton says she includes physician advisors in their CDI team.

“I'm looking for someone that I know Is going to be able to help me move an initiative forward,” she says. They need to be aware, she adds, “that the work that we're doing is going to either impact their patients or their RBUs and workflows directly, even if it's not that obvious.”

This is a new idea. Ansley pointed out that clinical leaders don’t often know how to navigate the administrative or RCM space, while Joann Ferguson, VP of the Revenue Cycle at Henry Ford Health, noted that RCM leaders and staff can be intimidated by clinicians or afraid of speaking with them. 

After all, clinical care is the sexy part of healthcare, while RCM is in the background. There are no RCM characters in Grey’s Anatomy, Chicago Med or The Pitt, and Doctor Robbie isn’t thinking about reimbursements when he’s saving lives in the ED.

Yet another growing opportunity for RCM leaders is to use AI to work directly with patients. By better understanding their financial situation and developing strategies that they can use to meet their financial responsibilities, RCM staff can help reduce delayed or missed payments, bad debt, and the costs that go into pursuing payments.

Ideally, AI offers the opportunity to look more closely at a patient’s ability to pay medical bills, analyzing all the factors that go into financial stability (including social determinants of health) and anticipating who might have problems. This also gives RCM departments an opportunity to coordinate with health plans, identify available loans and programs, and ward off bad debt before it happens.

“We have a tremendous opportunity to offer new services,” said Stephen Kos, MSHCA, CHCIO, Senior Director of Revenue Cycle for Baptist Health in Jacksonville, Florida.  

The immediate challenge for revenue cycle leaders is not simply acquiring new technology, but rationalizing and governing its use. Proliferation of similar solutions have led to redundancies that hamper cost savings, and health systems continue to face difficult decisions when it comes to using their EHR systems’ native tools versus outsourcing functions of the revenue cycle to vendors. 

Health systems with effective governance structures will recognize the most benefit from new solutions while those without clear strategies will struggle to recognize the efficiencies that technology can produce. As workflows become more reliant on technology, revenue cycle leaders are increasingly tasked with managing traffic at the intersection of IT, clinical, and financial operations. 

In some ways, increased reliance on technologies means that the revenue cycle leaders’ role becomes more human-centric: managing change, developing and reskilling staff, and building trust among senior leadership. Ultimately, the future of revenue cycle excellence belongs to the organizations that can master this transition.