Why Initial vs. Final Denial Rate Determines Your RCM Strategy

Mission-Driven Revenue Cycle: Denials Prevention, Proactive Loss Mitigation, and Agentic AI at a Safety Net Hospital

Thomasina Wilkins · Chief Revenue Officer, Sinai Chicago

Thomasina Wilkins brings a mission-first framework to claims denial management shaped by more than 25 years of cross-functional revenue cycle leadership across academic medical centers, safety net hospitals, and multi-specialty physician groups. As Chief Revenue Officer at Sinai Chicago, she describes how the proactive loss mitigation philosophy she has developed and shared internationally translates into a denials prevention partnership model that treats every touchpoint in the revenue cycle from scheduling and authorization through clinical documentation and appeals advocacy as a shared organizational responsibility rather than a back-end cleanup problem. The conversation covers how she prioritizes denial categories by return on investment, the distinction between preventable and non-preventable denials as a foundational step in denials management strategy, the importance of recalibrating denial targets every 60 to 90 days as payer behavior and government policy shift, and the unique challenge that medical necessity denials present for mission-driven safety net hospitals that cannot reduce clinical care in order to improve metrics. Thomasina closes with her perspective on agentic AI in the appeals process as the area with the most immediate step-function value, her call for vendors to develop customizable tools that match the specific denial patterns of safety net hospitals and rural facilities, and a leadership principle she returns to throughout: revenue cycle is everyone's responsibility, and lasting improvement requires shared vision across clinical, financial, and operational partners.