Preactive Patient Access: Prevent Denials and Reduce Uncompensated Care in Healthcare
Since 2000, U.S. hospitals have delivered nearly $745 billion in uncompensated care1. This number is projected to grow by an additional $204 billion over the next decade2. This is driven by insurance coverage gaps, claim denials, breakdowns in eligibility and benefits verification, and lack of upfront patient financial clearance conversations. Without effective patient access solutions, these challenges often result in a patient’s inability or unwillingness to pay.
The Growing Impact of Uncompensated Care on Healthcare Revenue Cycle
Unpaid and aging patient accounts continue to strain healthcare finances, forcing hospitals to absorb losses that often lead to budget cuts, staff reduction, and downsizing of essential but lower-revenue generating services like behavioral health and chronic care. Rural and safety-net facilities are particularly vulnerable, with some forced to shut down entirely. In 2024 alone, 18 rural hospitals closed their doors, affecting over 2 million Americans’ access to care. This ripple effect extends beyond finances, eroding access and quality of care for everyone.
Providers have a 70% chance of collecting at the point of service, but only 30% after the patient leaves.
In medical billing, time is critical. According to a survey, 70% of patients prefer knowing their costs upfront to better plan payments3, and 88% of healthcare providers agree that upfront price estimates improve collection success4.
This highlights the need to address front-end revenue cycle gaps—including eligibility verification issues, incomplete patient data, and coverage denials—to boost upfront collections and reduce revenue leakage.
Front-End Patient Access Strategies to Prevent Denials and Revenue Leakage
Nearly 50% of claim denials occur due to avoidable front-end issues like incomplete insurance verification or inaccurate patient data. Implementing proactive denial prevention strategies and establishing a clear reimbursement pathway before the visit, providers can autonomously detect and correct errors, reducing denials at their source.
- Integrated Financial Clearance
Automates eligibility and benefits verification, captures complete patient data during scheduling, and initiates prior authorization automation within 14–30 days before appointments5, eliminating up to 82% of preventable denials.
- Technology Enablers
Leverage AI to boost eligibility determination speed by 70–85% and shorten prior authorization cycles, integrating directly into the revenue cycle management (RCM) workflow for improved efficiency. Machine learning algorithms continuously improve accuracy, learning from patterns across millions of transactions to predict and prevent potential denials before they occur.
- Human Oversight
Over 60% of physicians report that unregulated AI tools have led to inappropriate denials of necessary care6. Human-in-the-loop ensures AI-driven denial prevention aligns with clinical judgment, preventing inappropriate denials.
- Process Optimization
Use behavioural analytics powered automated reminders to reduce no-shows while applying analytics-driven denial prevention strategies.
How IKS Health’s Preactive Patient Access Solutions Use AI and Human Expertise
The reactive, conventional method of denial management is no longer viable. Over $10.6 billion is lost disputing claims that should have been cleared on first submission, despite healthcare firms spending nearly $20 billion on claims delays and denials each year7.
IKS Health’s technology-powered, human-enabled patient access solutions are designed to reduce administrative burden, boost clinical productivity, and deliver smarter, faster, and more accurate results. It is supported by three key pillars:
- Cognitive autonomy
A continuously learning and adaptive AI engine that enhances accuracy, automates routine workflows, and proactively prevents errors using self-improving algorithms. - Behavioral intelligence
Leverages patient demographics and historical patterns to predict behavior, personalize engagement, and ensure appointment adherence to optimize collection. Advanced segmentation identifies patients most likely to respond to specific communication methods, significantly improving engagement rates. - Expert human support
Experienced professionals manage complex scenarios and feed insights into the AI loop, ensuring continuous learning and preserving institutional expertise.
These pillars work together to enable the IKS patient access solutions, giving organizations the ability to better understand their patients, build more empathetic and effective relationships, increase clinician efficiency, and drive stronger financial outcomes.
Patient Financial Clearance: Prevent Denials Before They Happen
IKS Health’s patient financial clearance engine blends cognitive intelligence with human expertise to protect revenue:
- AI-Driven Registration Integrity: Uses longitudinal patient profiles to autonomously detect and fix demographic errors while gaining insights into patient trends and learning from every encounter. It reduces avoidable front-end denials and guarantees registration integrity.
- Real-Time Eligibility And Benefits: Ensures that eligibility and benefits are accurately matched, removing any misalignments that can cause reimbursement delays or denials. In less than three seconds, the IKS patient access suite verifies insurance coverage while you focus on the patient.
- Intelligent Liability Estimation: Provides precise up-to-date out-of-pocket cost estimates in real time, avoiding billing surprises and improving financial transparency. Uncomfortable post-care payment discussions are avoided by offering upfront information, which increases point-of-service collections by 40%.
- Autonomous Prior Authorization: The prior authorization solution proactively identifies authorization requirements and, supported by a global expert workforce, initiates them ahead of patient encounters. It recognizes CPT codes that need prior auth, understands payer-specific regulations, and assembles all necessary documentation to streamline the process for providers and patients.
At the core of this solution is a human-in-the-loop model. While the engine handles most transactions autonomously, it flags complex cases for expert review, ensuring accuracy, adaptability, and continuous learning from every interaction.
Leveraging Patient Engagement and Behavioral Intelligence to Improve Collections
IKS’s intelligent patient engagement solution turns patient communication from a cost center into a strategic revenue driver. By analyzing behavioral patterns, it personalizes outreach and optimizes message delivery to align with individual preferences— making pre-payment easy and intuitive. Timely nudges about discounts, payment reminders, and personalized payment plans boost treatment adherence and financial compliance, ultimately improving reimbursement outcomes.
The Financial and Operational Impact of Technology-Driven Human-Enabled Patient Access
Actively preventing denials and avoiding costly write-offs can help hospitals recover up to $5 million in additional revenue, strengthening the bottom line and protecting margins8.
Intelligent, predictive models that combine available data with technology and human expertise are necessary to combat denials. Partnering with the right technology provider guarantees constant learning, deeper understanding into data patterns, and the ability to optimize workflows and models for best quality of care. By analyzing claims prior to submission, AI can flag missing data, coding errors, and insurance discrepancies, preventing reimbursement delays. In addition to direct uncompensated care reduction, improved cash flow, and higher payor reimbursements, the right combination of technology and human expertise can reduce administrative burden by 30-50%, and improves staff satisfaction and retention.
Join leading healthcare organizations already transforming their revenue cycles by reducing denials that drive uncompensated care. Schedule a consultation today to see how preactive patient access solutions can help you stop revenue loss before it starts.
- Fact Sheet: Uncompensated Hospital Care Cost
- Reconciliation Bill Effects on States’ Healthcare Spending and Uncompensated Care
- TransUnion Healthcare: 2021 Sees 55% Rise in Financial Assistance Transactions
- Experian: The State of Patient Access 2024
- Financial Clearance Integration in a High-Performing Revenue Cycle
- How AI is leading to more prior authorization denials
- Providers ‘wasted’ $10.6B in 2022 overturning claims denials, survey finds
- Best practice strategies to protect earned revenue through effective denials prevention
