Revenue cycle management (RCM) is changing rapidly, and it’s imperative for healthcare providers to pay attention to one of the most significant mega trends facing the industry.
Health services organizations are under more pressure than ever. Faced with the need to make investments in improving service excellence, it should be no surprise that there’s renewed focus on core business operations. The revenue cycle, the drive train of provider businesses, is in the bullseye of artificial intelligence (AI). Improving Healthcare Revenue Cycle Management (RCM) is a paradox: it’s notoriously costly, inefficient, and unpredictable to manage, yet failing to improve it carries serious risks, costly consequences, and leaves organizations uncertain about who to trust or how to move forward.
The revenue cycle leadership role is being elevated – they are becoming the Chief Revenue Officer, and they are tasked with protecting and improving cash flow, and driving operational improvements that reduce operating costs without any service implications. They are equally tasked in performing elements as a Chief Innovation Officer as well. It is a series of challenging dichotomies; one example is having to secure a stable, highly skilled workforce, while also having to stare down pronounced productivity deficits of both domestic and global resources.
Leaders are attacking these challenges with a measured approach but massively accelerated with Generative AI. Sustainable digital transformation requires a holistic, integrated approach to leveraging and improving the operating triad of people, process and technology. According to a survey conducted by the Deloitte US Center for Health Solutions, more than 70% of healthcare executives in the US, UK, Canada, Germany, Australia, and the Netherlands are prioritizing productivity and efficiency. There’s a strong push toward digital tools, AI, and workflow automation to close the productivity gap.
As evidence of this, we have identified 6 key areas of improvement focus. While not exhaustive, these share a common thread – they are core, granular processes within the revenue cycle that cause a lot of pain for all involved, and they are all solvable, quickly with technology-led strategies.
1. AI-Powered Predictive Denial Management
Denials remain one of the biggest revenue drains in healthcare and are often due to outdated eligibility, poor or inaccurate medical documentation/coding, or incomplete prior authorization data. According to the Optum 2024 Revenue Cycle Denials Index, 12 percent of claims were denied in 2023. In response, RCM teams are shifting from reactive denial management to proactive AI-powered denial prevention.
Advanced large language models are now analyzing clinical documentation to ensure that all clinical elements have been captured to support medical necessity prior to claims submission. With over 30% of denied surgical claims categorized as a “Request for Information”, it is mission critical to align medical documentation with payer guidelines for payment. Without the utilization of Generative AI, it is impossible for physicians to know the clinical requirements for all payers. Without the utilization of AI, physicians experience a sub-40% performance in paid appeals.
Early adopters of AI lead processes can see up to double-digit reductions in denial rates or 30% improvement in paid appeals which leads to faster revenue recognition. According to the Black Book “AI in Healthcare Finance: 2025 Market Review” 83% of healthcare organizations reported that AI-driven automation reduced claim denials by at least 10% within the first 6 months of implementation.
What this means for leaders:
Expect revenue cycle leaders to drive process change by selecting strategic partners that drive the overall Ai transformation journey. This transformation is essential for minimizing avoidable denials and shortening accounts receivable (AR) days (the average time it takes to collect payments). Organizations leveraging their own data for customized risk models will have a significant advantage.
2. Intelligent Prior Authorization Automation
Few RCM bottlenecks cause more frustration—or revenue delay—than prior authorization. On average, provider organizations reported spending 24 minutes requesting an authorization from a health plan using phone, fax, or an email and 16 minutes using a health plan portal — with the latter representing the greatest time spent conducting any administrative transaction using a portal. Prior authorizations frustrate providers, increase costs, and use significant amount of time due to ongoing changes in plan requirements, poor quality data, and low adoption rates. According to AHIP’s 2024 survey, nearly half of prior authorization requests for medical services (45%) are currently submitted by providers manually, using phone, fax or traditional mail.
In 2025, AI-driven automation tools are tackling this head-on. Generative AI platforms are reviewing the medical records prior to Prior Authorization submission to ensure the necessary clinical elements have been captured to assure a prior authorization is granted. Agentic AI is then being utilized for the actual submission of the prior authorization driving speed and efficiency — with fewer human touchpoints.
What this means for your revenue cycle:
Organizations still managing prior authorizations manually will fall behind. Leading RCM teams are piloting solutions that integrate directly with EMRs and payer portals to accelerate approvals.
3. Hyper-Automation in Patient Access and Eligibility
The patient’s financial experience now starts long before the first appointment. Health systems are embedding hyper-automation tools into patient access workflows to reduce eligibility errors and improve collections at the point of care.
Emerging capabilities include:
- Automated eligibility checks to verify insurance eligibility in real-time and predict upcoming eligibility issues (e.g., expiring coverage)
- Real-time insurance discovery to find hidden or secondary coverage
- AI-driven patient responsibility estimators for financial transparency
- Automated appointments and pre-registration portals with embedded eligibility logic
What this means for healthcare executives:
Clean claims start with clean patient data. Organizations investing in automated patient access workflows are seeing higher point-of-service collections and fewer downstream billing issues through the patient front door.
4. Generative and Agentic AI in Clinical Documentation, Coding, and Claims Submission
2025 marks a turning point in how AI supports clinical documentation improvement (CDI) and medical coding. The challenge for healthcare organizations is selecting a platform that will enable autonomous coding or prior authorizations for a multitude of specialties versus a few.
In 2025, AI-driven automation tools are tackling this head-on. Generative AI platforms are reviewing the medical records prior to Prior Authorization submission to ensure the necessary clinical elements have been captured to assure a prior authorization is granted. Agentic AI is then being utilized for the actual submission of the prior authorization driving speed and efficiency — with fewer human touchpoints.
Two distinct types of AI are now playing critical roles in RCM:
- Generative AI: Creates new outputs—like auto-suggested diagnosis codes, documentation summaries, and automated appeal letters for denials.
- Agentic AI: Takes action—such as submitting prior authorizations, flagging missing documentation in real time, or autonomously coding high-volume, low-complexity encounters.
These technologies are now assisting CDI teams and coders by reducing manual effort, improving accuracy, and accelerating claim submission.
What this means for your organization:
Human oversight remains essential, especially for complex cases, but expect AI to handle a growing share of routine coding and documentation tasks. The result? Faster throughput and reduced labor costs.
5. Real-Time Revenue Intelligence
Static, retrospective reporting is no longer enough for today’s fast-moving healthcare finance teams.
Leading organizations are implementing real-time revenue intelligence platforms that give instant visibility into:
- Days in AR
- Payer Specific Denial trends
- Cash collections
- Clean claim rates by provider, location, or payer
AI-powered dashboards enable RCM leaders to move from lagging indicators to real-time, actionable insights. Revenue cycle leaders can now request reports directly from the platforms via voice without having to initiate requests to the Business Intelligence infrastructure.
What this means for CFOs and Revenue Cycle Leaders:
Operational agility now depends on immediate access to performance metrics. Dashboards that highlight exceptions and emerging risk areas in real time are becoming a must-have—not a nice-to-have.
6. Cybersecurity Readiness Becomes a Revenue Cycle Imperative
The Change Healthcare breach was a wake-up call for the entire industry. For revenue cycle teams, cybersecurity is no longer just an IT concern—it’s now a direct threat to revenue continuity.
As provider organizations accelerate their adoption of AI, cloud-based platforms, and API-driven workflows across the revenue cycle, the attack surface—or the total number of potential entry points for hackers—is expanding rapidly. In the context of healthcare RCM, this includes EMR integrations, clearinghouse connections, API endpoints, claim submission portals, patient access tools, cloud-based AI platforms, and even third-party vendor systems—all of which create potential entry points for attackers.
Beyond just data breaches, these attacks can freeze cash flow, delay claims processing, and create AR backlogs that take months to recover from. The operational and financial consequences can be severe.
What this means for RCM leaders:
Expect cybersecurity readiness to become a standing agenda item for revenue cycle strategy discussions. CFOs and revenue leaders are now asking critical questions like:
- Do we have business continuity plans specific to RCM in the event of a cyberattack?
- How quickly can we shift to alternate clearinghouses or manual workflows if needed?
- Are our RCM vendors compliant with HITRUST, NIST, or other recognized cybersecurity standards?
Organizations that proactively address these vulnerabilities will not only protect sensitive data—but also safeguard revenue flow in the face of future disruptions.
The Takeaway: RCM Leaders Must Embrace Intelligent Automation—Now
The next era of RCM will be defined by how well organizations leverage Generative AI, to drive both operational efficiency and financial performance.
At Ascent Healthcare, we’re helping provider organizations navigate this shift—blending technology solutions, using Ascent’s ARMS Ai platform, with hands-on RCM expertise to deliver measurable, sustainable revenue gains.
Want to see how these trends could impact your bottom line?
Contact Ascent Healthcare for a strategy session tailored to your organization.
Bill Stone
EVP - US Healthcare, Ascent Health