Sift Healthcare

Market projections have RCM tech landing anywhere from $343B to nearly $900B globally by 2032. What's key is that #revenuecycle leaders aren’t just buying automation — they’re buying results. Solutions that lack measurable ROI, interoperability, or clinical-financial alignment aren’t making the cut. Health systems are looking for partners that can embed (useful) #AI into workflows and deliver real revenue impact. https://lnkd.in/gwa3MsYH

Innovation in the #revenuecycle (and more broadly, in healthcare finance) isn’t just about adopting the latest tech—it’s about rethinking entrenched challenges. Heather Dunn, MBA, CHFP, EHRC, CRCR captures exactly what it means to be a disruptor in this space: AI-powered claims analysis, proactive cybersecurity strategies, and payer transparency tools are reshaping the landscape. But as she points out, the real challenge isn’t just implementation—it’s ensuring adoption, compliance, and *meaningful impact* in a highly regulated environment. https://lnkd.in/gmuSkSQ8

Sift's 2024 Denials Insights Report is live. This very comprehensive report breaks down the biggest reimbursement trends impacting health systems—payer delay tactics, the rise in takebacks, and hidden clinical denials. #HIMSS #revenuecycle #hfma

The financial impact of claim denials is more unpredictable than ever. Payer tactics are evolving, takebacks are surging, and clinical denials are creating hidden revenue leakage. Sift's denials experts leverage #AI to analyze millions of claims and remittance records to uncover the real trends behind denials. Our 2024 Denials Insights Report highlights the most impactful denial trends from last year, including: 🔹 Emerging payer delay tactics that extend AR days and impact cash flow 🔹 The Change Healthcare data breach's impact on payment turnaround times 🔹 200% increase in payer takebacks—and what providers can do to fight back 🔹 Clinical denials that never show up in financial systems—leading to massive hidden revenue loss Download the full report to see what drove revenue cycle challenges in 2024—and how health systems can better respond in 2025. https://lnkd.in/gzWraBDA #RevenueCycle #DenialsManagement #RCM #HIMSS

As denial rates continue to rise, health systems need better, not just more, automation to reduce administrative burden and improve payment outcomes. Sift's CEO, Justin Nicols, shares how #AI copilots can transform CDI workflows by connecting clinical and financial data, helping teams focus on quality, efficiency, and high-value cases. #revenuecyclemanagement #revenuecycle

Denials management isn’t just about lost revenue—it’s about preventing revenue leakage before it happens. Our partners at Solventum break down why traditional reactive approaches are no longer enough and how proactive denials management is transforming revenue cycle resilience. By integrating denials intelligence across CDI, coding, and #revenuecycle teams, health systems can eliminate root causes, reduce compliance risks, and strengthen financial performance. This shift from chasing denials to preventing them at the source is critical as financial pressures on healthcare organizations continue to mount. https://lnkd.in/gsge_beV #CDI #HIMSS

Insurance payers are expected to start charging providers to appeal rejected claims. All while denials only continue to *increase* and the admin cost to appeal a denial is already upwards of $100. Proactive denials management has never been more essential (and to truly prevent denials, providers need AI-driven solutions that can predict them and provide actionable recommendations for mitigation). Paywalled, so some key snippets: "Rates and timely reimbursements have always been sticking points, but providers say health insurance companies are snarling them with restrictions, such as more stringent prior authorization requirements." “There's this whole front accelerating between insurers and providers that is not really about rates. It's more about appeals and denials. Insurers would much rather say no to a provider than a patient,” said Katherine Hempstead, senior policy advisor at the Robert Wood Johnson Foundation Beginning in March, Blue Cross Blue Shield of Michigan will assess fees when providers appeal some commercial claims. If a state external review board rules in favor of Blue Cross twice, the insurer will bill providers for the administrative costs associated with defending itself. https://lnkd.in/gFgpXNvU

New data from Kaufman Hall shows bad debt and charity care have jumped 7% year over year, with significant regional variation (the Midwest saw a 21% increase). Hospital size also plays a role, with mid-sized hospitals experiencing the biggest hit. The Sift team is seeing these shifts in our analytics—patient balances are climbing, and the mix of self-pay patients is growing. As healthcare organizations explore new financial strategies—like moving payments earlier and adopting data-driven payment plan offerings (finite segmentation)—this data provides critical context. And amidst this shift, congrats to our partner, State Collection Service, Inc., for earning a KLAS Research award for their Bad Debt Solution—a well-deserved recognition in an increasingly complex revenue environment. https://lnkd.in/gT9dPGrU #healthcarefinance #ViVE #HIMSS

AI is no longer a future-state vision for value-based care. As Robert E. Connely III from Pegasystems highlights, in 2025, machine learning and predictive models will help track real-world outcomes, optimize resources, and personalize patient engagement—at scale. Aggregating clinical and financial data and the strategic application of #AI is critical to enabling these key elements of (sustainable) #valuebasedcare. https://lnkd.in/esfGpCUe

The documentation burden in healthcare is growing—and so are the challenges in maintaining accuracy, compliance, and efficiency. With payment models evolving, CDI has never been more critical. Incomplete or inaccurate documentation doesn’t just impact reimbursement—it affects patient care, quality reporting, and overall revenue integrity. AI-driven CDI solutions are essential to: -Prioritizing high-impact documentation interventions -Supporting clinicians with real-time notifications at the point of care -Reducing denials and protecting reimbursement https://lnkd.in/g-jmTJPE Solventum #HIMSS #ViVE #revenuecycle