The Results Are In: AI in Healthcare is Working

How Healthcare Leaders Can Turn Pilot Projects Into Sustainable, System-Wide Results

AI is no longer a buzzword in healthcare. It now has its own budget line, and it’s already reshaping the way healthcare gets delivered and paid for. More than 80% of healthcare organizations report active AI projects, but only 18% have a mature strategy for scaling and governing them. That gap isn’t just a statistic—it’s the difference between isolated wins and enterprise-wide, sustainable impact. Every missed eligibility check, coding error, or delayed claim puts margin at risk 

The good news: AI is already delivering measurable wins in revenue cycle management (RCM) and clinical operations. The challenge? Too many organizations are still stuck in “pilot mode,” with projects that look good on paper but never fully scale. The next 12 to 18 months will determine which leaders turn early experiments into enterprise-wide advantage; and which are left behind. 

What’s Working Now

AI’s most meaningful wins aren’t flashy—they’re foundational. In revenue cycle operations, AI is: 

• Automating eligibility and benefits verification: reducing missed checks that delay reimbursement and helping providers collect payments up to 30% faster. 

• Streamlining prior authorizations: cutting turnaround times from days to hours and improving first-pass approval rates. 

• Identifying coding issues before they become denials: lowering denial rates by as much as 20–30% and preventing costly rework. 

• Surfacing actionable insights for faster reimbursement: enabling revenue leaders to proactively address underpayments and reduce A/R days. 

 Healthcare organizations are seeing measurable ROI: shorter days in A/R, fewer write-offs, reduced manual workload, and higher staff satisfaction. 

The Barriers Still Holding AI Back

However, even with 80% adoption, most organizations struggle to scale AI effectively. Common challenges include: 

• Data readiness: Unstructured inputs and disconnected systems slow progress 

• Change management: Staff may resist tools they feel are confusing or disruptive 

• Workflow alignment: Even good AI sits unused if it doesn’t integrate seamlessly 

• Governance: Lack of standards can lead to compliance risks or poor trust

A Practical Roadmap for Smarter AI

To move from pilot to enterprise-scale success, follow a structured approach: 

1. Define Your Objectives: Focus on cash flow, denials, documentation, and patient experience gaps. 

2. Clean Your Data: Standardize eligibility, charge, and documentation inputs before scaling. 

3. Select the Right Solution for You: Choose tools that fit your workflows and deliver measurable ROI. 

4. Pilot and Prove: Start small to demonstrate quick wins and build organizational buy-in. 

5. Measure Relentlessly: Track net collections, denial rates, days in A/R, and documentation completeness. 

6. Build Long-Term Governance: Ensure models are accurate, explainable, and monitored for performance.

The Payoff

Organizations that get this right are seeing measurable ROI: faster reimbursement, fewer denials, improved staff satisfaction, and stronger patient loyalty. The smartest leaders aren’t asking if they should use AI. They’re asking where it can deliver the most value today and how to make it stick long-term. 

Ready to Go from AI Pilot to AI Proof?

AI adoption isn’t optional—it’s imperative for today’s RCM. Every missed eligibility check, coding error, or delayed claim puts margin at risk, and pilot projects that never scale leave money on the table. 

 Healthcare leaders who win with AI are those who: 

•  Optimize Continuously: Measure relentlessly and refine workflows until the gains are baked into operations. 

•  Earn Team Trust: Pair AI with smart staff augmentation so people focus on exceptions, not rework. 

•  Govern with Confidence: Monitor models for accuracy, compliance, and ROI over time. 

Margins are too thin to stay in pilot mode. The next 12–18 months will determine which organizations turn early wins into sustainable, enterprise-wide results — and which fall behind. Now is the time to move from promising tests to proven outcomes with governance, measurement, and a clear ROI at every step.  

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About Access Healthcare

Access Healthcare stands as one of India's largest and fastest-growing providers of healthcare business processes and technology solutions. Our team of over 27,000 professionals operates from 20 service delivery centers across three countries, emphasizing global delivery, workflow optimization, and our award-winning AI-enabled technology platform.

Since 2011, Access Healthcare has been a trusted partner to the US healthcare sector, leveraging domain expertise, technology, automation, and analytics to enhance clinical outcomes, financial performance, and operations for healthcare providers and payers.

Let’s build something stronger together.

Contact us to explore how our holistic approach to revenue integrity—powered by automation, analytics, and human insight—can support your goals.

Happy to Achieve an Industry Benchmark? Don’t Be

Ridda Domenech
Vice President, Access Healthcare

Why Being “Average” Is Failing Ambulatory CFOs in 2025

For financial executives in charge of ambulatory care facilities, today’s revenue cycle management (RCM) benchmarks are not a “destination” for operational performance. What once looked like a mark of solid performance now mirrors a broken system: rising denials, bloated A/R, and creeping bad debt. Achieving “industry average” doesn’t necessarily mean you’re financially healthy. It really means you’re standing on quicksand, and three years from now, what felt like firm financial footing will have you looking up the walls of a cash flow sinkhole. 

Your goal isn’t achieving industry benchmarks—it’s to push to surpass them. You can’t just monitor cash flow. You must diligently defend it against payer friction, patient responsibility, and operational lag. 

Too many CFOs fall for what can only be called fool’s goals: aiming just to match industry averages or tracking activity metrics that look impressive but have no real bearing on margin or cash flow. Don’t celebrate KPIs like volume of claims processed, percentage of scheduled visits completed, or “manual touchpoints minimized.” These metrics do not guarantee financial strength or stability.

The Real Numbers That Demand More Than “Average”

Here’s how the industry’s 2025 ambulatory care benchmarks look (notice how “average” is rarely enough):

Metric	Industry Average (2025)	Best-in-Class Target
Days in A/R	30–50 days	Under 30 days
% A/R Over 90 Days	22.5%	Under 15%
Initial Denial Rate	10–15%	Under 5%
Net Collection Rate (NCR)	95%+	97–98%
Bad Debt as % of Gross Revenue	2–3%	Under 1.5%

• A “benchmark” denial rate leaves 1 in 10 claims unpaid—a direct hit to margin. 

• NCR at 95% means accepting a steady stream of write-offs — enough to push many outpatient groups into the red. 

• Every day above 30 in A/R ties up six figures or more in stagnant revenue for mid-sized clinics. 

Why Top Performers Refuse to Settle

CFOs winning in 2025 are the ones who: 

• Aggressively compare internal metrics not against the median, but against the best-performing 10 percent (top decile) of organizations in their peer group.  

• Root out “fool’s goals” and double down on KPIs that directly drive margin, which is actual money in the bank, not dashboard vanity numbers. 

• Demand RCM partners who have a track record of taking providers from average to elite (and have the reporting and guarantees to back it up).

Why Strategic RCM Partners Matter

The distance between “average” and “industry leader” is growing rapidly. CFOs cannot afford to cling to benchmarks built for an outdated system, nor can they wait years for internal fixes.  

This is why forward-looking RCM partnerships are game changers: 

• Agentic AI capabilities instantly adapt to changing payer rules, proactively flag and resolve denials, and automate appeals. 

• Full Transparency delivers dashboards that synchronize revenue cycle metrics with payer contracts and bottom-line outcomes, eliminating “black box” analytics. 

Together, they empower CFOs to compete at the payer level, instead of fighting yesterday’s battles with yesterday’s tools.

Real-World Margin Impact

Going beyond benchmarks isn’t theoretical, it’s immediately measurable: 

• Each five-day A/R improvement in a $10M practice delivers $137,000 in cash flow. 

• Cutting denial rates by just 2 percent can return six figures a year to a mid-size clinic. 

• Improving net collection from 92 percent to 96 percent recovers hundreds of thousands in lost revenue. 

These are not abstract “ops wins.” They’re direct defenses of your financial margin. 

CFO Self-Check: Are You Chasing Fool’s Goals?

Ask these critical questions: 

• Is your A/R aging over 50 days? 

• Are more than 20 percent of receivables over 90 days? 

• Is your net collection rate under 95 percent? 

• Is bad debt taking more than 3 percent of revenue? 

If yes to any of these, you’re measuring against fool’s goals. And in 2025, that’s not survival—it’s financial submission.

Stop Chasing Benchmarks. Start Setting Them.

In 2025, “average” performance isn’t survival—it’s surrender. CFOs who lead the pack are no longer content with 95 percent net collection rates or 50-day A/R. They’re setting goals that push their RCM partners to deliver elite performance—and they’re seeing the margin gains to prove it. 

If your numbers look “fine” on paper but you’re still fighting cash flow headaches, denials, or patient bad debt, that’s your signal. It’s time to demand more. 

Your Next Steps:

Audit Your Metrics: Compare every key RCM KPI against best-in-class targets, not industry medians. 

• Prioritize Margin-Impact KPIs: Focus on A/R, denials, and net collections over vanity stats like claim volume or touchpoints. 

• Partner with Performers: Work with an RCM team that proves they can take providers from “good enough” to top decile with transparent reporting and guaranteed outcomes. 

Don’t let “industry standard” become your ceiling.  In 2025, playing it safe will cost more than ever. Lead with ambition. Set bold goals, demand more from your partners, and hold your RCM to best-in-class standards. The margin you defend today is the difference between tomorrow’s surviving versus thriving. 

Get a Complimentary Performance Review 
Access Healthcare’s experts will benchmark your revenue cycle against best-in-class targets, identify margin leaks, and deliver a roadmap to move from average to elite. 

Schedule Your RCM Benchmark Review 

Because in 2025, the cost of standing still is measured in millions, and the CFOs who win are the ones who refuse to settle for “average.” 

About the Author 

Ridda Domenech is Vice President of Sales at Access Healthcare, where she brings more than 25 years of experience transforming healthcare service delivery and strengthening client partnerships. With a career spanning payer, provider, and patient-facing operations, Ridda has led enterprise programs, high-performing teams, and multimillion-dollar growth initiatives across the healthcare ecosystem. She partners closely with clients to understand their unique challenges and deliver revenue cycle management solutions that improve efficiency, protect margins, and support long-term growth. Her expertise includes revenue cycle management, scalable service delivery models, and client retention strategies that deliver measurable results.

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About Access Healthcare

Access Healthcare stands as one of India's largest and fastest-growing providers of healthcare business processes and technology solutions. Our team of over 27,000 professionals operates from 20 service delivery centers across three countries, emphasizing global delivery, workflow optimization, and our award-winning AI-enabled technology platform.

Since 2011, Access Healthcare has been a trusted partner to the US healthcare sector, leveraging domain expertise, technology, automation, and analytics to enhance clinical outcomes, financial performance, and operations for healthcare providers and payers.

Let’s build something stronger together.

Contact us to explore how our holistic approach to revenue integrity—powered by automation, analytics, and human insight—can support your goals.

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