Why Denials Are Symptoms, Not the Real RCM Problem
Kimberly Scaccia reframes how revenue cycle leaders should approach claims denials, arguing that organizations stay stuck in reactive postures because they treat denials as the problem rather than as a symptom of something upstream. She traces them to two root causes: a broken revenue cycle process or payer behaviors that create delays. TriHealth's 18-month strategy responds by shifting upstream to fix root causes, partnering more closely with managed care on service-level expectations, and moving from reactive denial management toward predictive AI that identifies likely denials before claims are submitted.
Key Takeaway
Chasing denials reactively addresses symptoms while leaving root causes intact. Revenue cycle organizations that shift upstream to repair broken processes and predict denials before they occur stop building teams to clean up what they should have prevented.
“denials are typically a symptom of one of two things: a broken revenue cycle process or payer behaviors that result in delays.”
Kimberly Scaccia, Vice President of Revenue Cycle, TriHealth
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