Revenue Cycle Analytics Archives

Prioritizing Denials: How to Find the Recoverable Dollars in Your Denial Workqueue

Most denial workqueues direct users to work accounts from oldest or largest first, assuming that recovery will follow. It seems like a reasonable assumption, but it’s wrong in a way that costs health systems real revenue (and wastes valuable time/touches)....

June 23, 2026

5 Levels of Denial Reporting — And Why Most Health Systems Stop at 3

Denials

5 Levels of Denial Reporting — And Why Most Health Systems Stop at 3

Your EHR denial reporting probably answers these questions well: How many accounts did each rep touch? Which queues are aging? What’s your denial rate by payer? Those are legitimate operational questions. But they’re activity questions, and activity isn’t outcome. The...

May 21, 2026

6 Things Aetna’s SOI Policy Is Breaking In Your Revenue Cycle

Claim Denials Denials

6 Things Aetna’s SOI Policy Is Breaking In Your Revenue Cycle

Last month, we wrote about the updated Aetna Medicare SOI policy and what it means for inpatient reimbursement. Since then, we’ve been watching how this plays out operationally, and the picture is more complicated than the policy summary suggested. What...

May 4, 2026

How to Know if a Denial Cluster is Worth Automating with an AI Agent

Denials Revenue Cycle Analytics

How to Know if a Denial Cluster is Worth Automating with an AI Agent

Agentic AI is being hailed across the revenue cycle right now, for appeals, claim resubmissions, documentation retrieval and a slew of other workflows. For the most part, the use cases make sense on paper. But many health system revenue cycle teams are making deployment decisions based on...

April 30, 2026

Segment Loop 2110: Another Way Your 835 Isn’t Showing Your Denials

Denials Revenue Cycle Analytics

Segment Loop 2110: Another Way Your 835 Isn’t Showing Your Denials

The Loop 2110 segment was designed to communicate payer decisions. But payers have moved on, and health systems still managing denials through the remittance file are working with an incomplete picture. We’ve seen an influx of Google searches for “835...

April 15, 2026

Aetna’s SOI policy is changing inpatient reimbursement without showing up as a denial.

Claim Denials Revenue Cycle Analytics

Aetna’s SOI policy is changing inpatient reimbursement without showing up as a denial.

Last week, we wrote about PLBs and how revenue is being pulled back after payment in ways most teams aren’t actively monitoring. We’re also seeing a similar dynamic show up earlier in the process. Aetna’s SOI-based inpatient policy approves stays...

April 8, 2026

Most providers aren’t monitoring PLBs. Payers know it.

Denials Revenue Cycle Optimization

Most providers aren’t monitoring PLBs. Payers know it.

PLB data is rich in information, telling you which payers are recouping, how often, and in what patterns. But you won't see it in static retrospective RCM reports or standard denial dashboards. If your team isn't actively monitoring PLB activity...

March 31, 2026

Sift’s Fourth Annual Denials Insights Report

Revenue Cycle Optimization

Sift’s Fourth Annual Denials Insights Report

Sift Healthcare's Fourth Annual Denials Insights Report analyzes 2025 payer behavior trends and how they are reshaping the way health systems measure reimbursement risk.

March 9, 2026

Beyond Denials Management – Adverse Payment Outcomes

Revenue Cycle Optimization

Beyond Denials Management – Adverse Payment Outcomes

Revenue cycle teams spend enormous energy managing denials, yet health systems still lose revenue. Here’s the case for a broader approach.

February 11, 2026

Claim Denials

2022 Healthcare Denials Insights

Denials are a significant and persistent obstacle for health systems and hospitals. They slow down receivables and add unnecessary administrative burdens. Sift Healthcare’s 2022 Denials Insight Report contains granular denials insights and action items to track root causes, prevent denials,...

March 1, 2023

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Tag: Revenue Cycle Analytics