Insights for Healthcare revenue leaders
The healthcare revenue cycle is more complex than ever. At Action RCM, we share practical strategies, executive perspectives, and industry insights to help leaders protect margins, improve patient experience, and accelerate recovery.
Prevention vs. Appeals: Where to Focus Denials Management Resources in 2026
In 2026, denials management is no longer a volume game. It is a margin game. Hospitals are facing rising payer friction, tighter reimbursement policies, and limited capacity to expand headcount. In that environment, the smartest organizations will stop treating...
The Revenue Cycle Squeeze: How Hospitals Can Recover More Without Increasing Headcount
Hospitals are facing one of the most persistent paradoxes in modern healthcare finance: revenue pressure is rising, but the resources to address it are shrinking. Margins remain thin. Labor costs are still elevated. Denial volumes are climbing. Payers are becoming...
The Cost of Not Appealing: What Hospitals Lose When Denials Go Unworked
Denials aren’t just a revenue-cycle nuisance. They’re a hidden profit-and-loss line item and when they go unworked, hospitals quietly donate earned reimbursement back to payers. That “donation” is growing. Benchmarking and survey data continue to show denial pressure...
COB Denials: The Most Preventable Revenue Leakage in the Hospital Revenue Cycle
In the complex world of hospital reimbursement, few denial categories are as deceptively costly and consistently overlooked as Coordination of Benefits (COB) denials. While clinical, prior authorization, and level-of-care denials often get the most attention, COB...
AI vs. Human: Who Should Manage Denials in Today’s Revenue Cycle Management?
By Action RCM Powered by Harris & Harris In the modern healthcare ecosystem, denials have quietly become one of the most expensive leak points in hospital revenue. On average, 10–15% of all claims are denied at least once, with up to 65% of those denials never...
Cracking the Code: How Hospitals Can Manage Veterans Administration (VA) and TRICARE Denials
Written by: Janice McGoldrick, VP of Revenue Cycle Management As hospitals work to stabilize revenue amid increasing payer scrutiny, Veterans Administration (VA) and TRICARE denials continue to challenge even the most experienced revenue cycle teams. Though both...
MVA & Workers’ Comp Denials: Why They Require a Different Playbook
A Growing Denial Challenge Motor vehicle accident (MVA) and workers’ compensation (WC) claims represent a unique challenge in the healthcare revenue cycle, one that can’t be managed with the same strategies used for commercial or government payer denials. These...
Top 10 Root Causes of Hospital Denials—And How to Prevent Them
Written By: Janice McGoldrick, VP of Revenue Cycle Hospital claim denials remain one of the most persistent and costly challenges in healthcare revenue cycle management. Nearly one in ten hospital claims is denied on first submission, and more than half of those...