By Bruce Nelson, Vice President, Access Healthcare
In Part 1 of this series, we explored how rising claim denials are quietly undermining the financial stability of healthcare organizations by driving up costs, draining staff time, and eroding patient trust. These challenges aren’t new. For years, hospitals and health systems have tackled denials through processes known as denial management.
But the industry has changed. Denials are now more frequent, complex, and costlier than ever before. Traditional denial management, built on reacting claim by claim, falls expensively short.
At Access Healthcare, we believe it’s time to go beyond old-school denial management. This isn’t just about fixing broken claims as they come in. It’s about building a smarter, strategic Revenue Defense System: a comprehensive approach designed to prevent denials before they happen, rapidly resolve those that do, and protect your organization’s financial health from end to end.
Here’s how healthcare organizations can move from playing reactionary defense to taking control—reducing losses, accelerating cash flow, and restoring trust at every stage of the revenue cycle.
Step 1: Prevent Denials Before They Happen
The most effective denial is the one that never occurs. Prevention starts on the front lines with accurate data capture, eligibility checks, and prior authorization workflows.
High-impact prevention tactics include:
Automated eligibility verification before the patient arrives
Real-time authorization validation tied to payer rules
Upfront demographic and insurance data scrubs to reduce avoidable rework
Clean claim edits built on historical denial trends
These tools minimize “avoidable denials”—the ones that stem from missing info, timing issues, or incomplete documentation. And they work best when integrated with intelligent automation platforms like those used by an RCM specialist like Access Healthcare.
Step 2: Categorize, Prioritize, and Analyze
When denials do happen, the goal is speed + accuracy, not just reaction.
Start by creating structured denial categories by payer, code, and cause. This allows teams to spot trends, identify root causes, and measure improvement over time.
Access Healthcare helps clients build custom denial dashboards to:
Track denial patterns by department, specialty, and payer
Prioritize high-dollar or high-frequency denial categories
Surface repeatable errors that can be fixed at the source
This step is critical not only for resolving today’s claims, but also for preventing tomorrow’s.
Step 3: Automate Appeals and Recovery
The appeal process is often too manual, too slow, and too expensive to scale. But with the right automation and workflows in place, you can significantly reduce turnaround times and reclaim revenue faster.
Best practices include:
Automated appeal letter generation based on denial type
Standardized escalation workflows by payer rules
Predefined resolution playbooks to guide teams quickly
Access Healthcare supports appeal workflows with trained denial experts, RCM platforms, and AI tools that flag incomplete or misprocessed remittances. This combination has helped clients reduce appeal cycles by up to 40 percent.
Step 4: Stop Underpayments from Flying Under the Radar
Even when a claim isn’t denied outright, it may be quietly underpaid. These often go unnoticed unless you're looking for them.
Hospitals leave millions on the table every year due to:
Payers misapplying contract terms
Auto-remits closing out claims prematurely
Staff lacking time to cross-check fee schedules
We help providers implement automated remittance audits to flag discrepancies and pursue proper payment, especially on high-volume, low-dollar claims that often get ignored.
Step 5: Bring It All Together With the Right Partner
Managing denials isn’t just about reacting faster—it’s about building resilience into your revenue cycle. That’s why Access Healthcare partners with hospitals, health systems, and RCM vendors to deliver:
Denial prevention through front-end process design
Real-time denial analytics and actionable insights
Dedicated and specialized teams to manage appeals, rework, and recoveries
Continuous improvement plans tailored to each client
The Bottom Line: Denials Are a Systemic Threat, But They’re Not a Lost Cause
You don’t have to accept denials as the cost of doing business. By investing in smarter processes, better data, and proven partners, healthcare organizations can reduce losses, accelerate cash flow and, perhaps most importantly, restore trust with patients and staff.
Ready to stop leaving revenue on the table? The time for a smarter, more resilient revenue cycle is now.
About the Author
Bruce Nelson is Vice President of Sales at Access Healthcare, part of the Smarter Technologies family. With more than 30 years of experience in the healthcare industry, Bruce brings deep expertise in revenue cycle management, strategic growth, and client success. Throughout his career, he has helped healthcare organizations streamline operations, reduce costs, and enhance financial performance through innovative, data-driven solutions.
Bruce is known for his ability to build strong, trust-based relationships with clients and partners, and for leading high-performing, results-oriented sales teams. His passion lies in equipping providers and healthcare systems with the tools and insights they need to thrive in a complex and fast-evolving healthcare landscape.
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.