Denials are growing faster than most RCM teams can respond. Payers are scaling AI-powered reviews across evolving policy frameworks. Yet many hospitals are still fighting them manually. This is beyond being inefficient. It's ultimately unsustainable. When payers can deny in seconds but your team needs days to appeal, you're fighting an uphill battle and leaving revenue on the table. We analyzed countless successful complex denial overturns across top payers (Aetna, Anthem, Un

The Sepsis Denial Crisis in Hospital Revenue Cycles Sepsis-related DRG downgrades are among the most financially damaging and preventable forms of revenue leakage hospitals face. When payers retrospectively challenge sepsis diagnoses and downgrade them to simple infections or pneumonia, the financial hit is immediate: $3,000 to $7,000 lost per case, and over $15,000 for more complex claims. But the impact goes deeper. These downgrades reduce your Case Mix Index (CMI), lowerin

Preparing for the New Era of AI-Powered Audits The Landscape is Changing – Are You Ready? DRG downgrades are on the rise. Medicare...