HFMA 2025: A Practical Guide for the Healthcare Admins who Couldn’t Make it to Denver
- Oran Lopez Reed
- 4 days ago
- 5 min read
Opening Scene: UC San Diego's Reality Check
Mike Vigo, Chief Revenue Cycle Officer at UC San Diego Health, took the stage with Evan Goad to share something refreshing: real implementation data from their Revenue Cycle Management Technology Adoption Model (RCMTAM) assessment.
The health system discovered they were missing 47% of what FinThrive considers "mission-critical" RCM technologies. That's nearly half the capabilities their peers consider essential for maintaining margins in 2025. And UC San Diego isn't some struggling community hospital, but a leading academic medical center with Epic fully deployed.
This wasn't an isolated revelation. Throughout HFMA 2025, a pattern emerged: even well-resourced health systems are operating with significant technology gaps, while vendors promise AI miracles that may or may not materialize.
Four Notable Trends from the Conference Floor
1. The Autonomous Coding Reality: Proceed with Caution
Mercyhealth's Kimberly Scaccia presented their journey with Arintra's autonomous coding solution. What made her presentation credible wasn't the success claims—it was her admission of what didn't work:
Initial accuracy rates were "disappointing" (she didn't share exact numbers)
Physician resistance was significant
Integration with existing workflows took twice as long as projected
Vendor Landscape Reality:
3M's 360 Encompass: Still requires significant human oversight despite "AI-powered" claims
Optum's Computer-Assisted Coding: Works well for straightforward cases, struggles with complex scenarios
Aidéo Technologies: Newer player making bold claims about autonomous coding—jury's still out
Epic's internal coding tools: Getting better but still lag behind specialized vendors
What Actually Works: Start with computer-assisted coding for high-volume, low-complexity encounters (think urgent care visits). Save the "autonomous" dreams for 2027.
2. Payer Denials: The Arms Race Requiring Strategic Partnerships
One session revealed that despite all the technology investments, denial rates haven't meaningfully improved industry-wide since 2019. Why? Payers are using the same AI tools to create more sophisticated denial strategies.
The Uncomfortable Truth: Several "point solution" denial management platforms showed minimal improvement over manual processes when you factor in implementation time and ongoing maintenance. One vendor (who shall remain nameless per their request) admitted their advertised "60% overturn rate improvement" was based on a sample size of 12 claims.
The Smarter Approach: Leading organizations are moving away from one-size-fits-all solutions toward development partnerships with innovative vendors. Monument Health's success wasn't just about buying technology; it was about co-developing workflows with its partners.
Action Items by Organization Type:
Academic Medical Centers:
Seek vendors willing to enter development partnerships for complex clinical denials
Look for solutions that learn from your physician documentation patterns
Structure contracts with shared risk/reward based on actual overturn rates
Consider being an alpha site for promising technologies in exchange for influence over product development
Community Hospitals:
Partner with vendors who understand your resource constraints
Negotiate pilot programs with success-based pricing
Look for vendors offering collaborative implementation models
Focus on partners who can grow with your organization
Critical Access Hospitals:
Join forces with similar facilities to negotiate better partnership terms
Seek vendors with proven rural hospital experience
Consider phased implementations that match your cash flow
3. The SDOH Documentation Gold Rush: Early but Intriguing
The emphasis on Z-codes as "economic levers" generated significant buzz, but the implementation examples were limited. One presenter showed impressive slides about integrating SDOH screening into workflows, but when pressed during Q&A, admitted they were "still in pilot phase" with actual Z-code capture.
Current State:
Most EMRs can capture SDOH data, but struggle with the coding translation
Payer reimbursement for SDOH-related services remains inconsistent
CMS 2026 proposals are still proposals, don't bet the farm yet
Practical Next Steps:
Start collecting SDOH data even without immediate reimbursement
Train registration staff on sensitive screening conversations
Build community partnerships before the technology integration
Track your baseline Z-code capture rate (it's probably under 5%)
4. The Workforce Evolution: Right Tools, Right Time, Right Partners
Yes, 60% of hybrid RCM workers are considering leaving. But the conference revealed a more nuanced story about timing and approach:
The Real Insight: Organizations succeeding with AI aren't replacing workers; they're elevating them. The key is finding the right technology partner at the right stage of your organization's journey.
Timing Matters:
Early Stage (Manual Processes): Focus on workflow standardization first
Growth Stage (Basic Automation): Ready for AI-assisted tools with strong vendor support
Advanced Stage (Optimized Workflows): Prime candidates for cutting-edge AI partnerships
UC San Diego's Approach (Worth Noting): They discovered through RCMTAM that being "advanced" in some areas didn't mean they were ready for everything:
Some departments were ready for autonomous coding pilots
Others needed basic workflow improvements first
Success came from matching technology to readiness, not forcing universal adoption
Finding the Right Partner: The best vendors at HFMA weren't selling products, they were seeking development partners:
Willing to customize solutions to your workflows
Offering success-based pricing models
Providing dedicated implementation support
Committed to growing with your organization
Signs You've Found the Right Match:
They ask about your 3-year strategy, not just immediate pain points
They offer to pilot with shared risk
Their team includes clinical and coding experts, not just salespeople
They're transparent about what their technology can and cannot do today
Your Realistic 2025 Action Plan
For This Quarter (Immediate Actions)
Run an Honest Technology Audit
Create an honest assessment of your revenue cycle - don't be afraid to seek outside help.
Include front-line staff in the evaluation (they know what actually works)
Document integration points and data flow bottlenecks
Pick One Strategic Partner for Focused Improvement
Find a vendor willing to co-develop solutions rather than buying a tool.
Look for partners offering development deals with favorable terms for early adopters
Set collaborative 90-day goals with shared accountability
Structure agreements that let you influence product roadmaps
Start Measuring What Matters
Denial rate by root cause (not just overall rate)
Time from service to final payment
Staff hours per claim processed
False positive rates from any AI tools
For 2025 (6-Month Initiatives)
Pilot AI-assisted coding in one department
Implement cross-functional denial prevention teams
Develop physician scorecards for documentation quality
Focus on authorization automation
Standardize workflows across facilities
Consider regional partnerships for specialized services
Join a collaborative RCM network
Outsource complex appeals
Invest in basic workflow automation before AI
Looking Ahead: 2026-2027 Predictions
Based on conference discussions and off-the-record vendor conversations:
Consolidation is Coming: Expect major RCM vendors to acquire nimble startups. If you're considering a newer vendor, ask about their funding runway.
Payer-Provider Tech Arms Race: Both sides will invest heavily in AI. The winners will be those who also invest in human expertise to oversee these systems.
Value-Based Care Reality: Full transition remains 5-7 years away for most organizations. Don't abandon fee-for-service infrastructure yet.
An Uncomfortable Conclusion
HFMA 2025 revealed an industry caught between transformation hype and operational reality. While many hospitals showed genuine improvement in their case studies, these successes required significant investment, time, and organizational commitment that many hospitals simply can't afford.
The path forward isn't about finding the perfect technology solution; it's about honest assessment of your organization's capabilities, realistic goal-setting, and incremental improvement. The vendors selling "transformation" might be disappointed, but your CFO will thank you.
Three Final Thoughts on HFMA 2025:
If a vendor doesn't come prepared with implementation timelines for your specific use case, walk away
Every "AI-powered" solution still requires human oversight so budget accordingly
The best technology investment might be in training your existing staff
Compiled from HFMA 2025 sessions, vendor discussions, and post-conference debriefs. Individual results may vary significantly from the presented case studies.
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