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, UnitedHealthcare,...

A federal court just blocked CMS's plan to use statistical extrapolation  in Risk Adjustment Data Validation (RADV) audits. MA plans may be celebrating but if you're a provider, here's what you need to understand: The burden of documentation falls on you either way. Whether CMS is using extrapolation or not, your documentation is the foundation of every audit. When payers first review your records, your job is to prove that every diagnosis and procedure was supported by clear, compliant...

Cofactor's founders share insights from DMEx, Open at Epic, and RIS 2025: why patient registration is every hospital's #1 denial problem, payer contract tactics, Epic integration challenges, and what revenue integrity leaders are doing about increasing denials. Watch the full video breakdown.