Changing the Healthcare Revenue Cycle Workflow to Improve Efficiencies with a New Preactive Paradigm

Healthcare revenue cycle leaders today face a perfect storm: shrinking margins, rising operational costs, workforce shortages, and ever-stricter payer demands. As patient populations age and the disease burden rises, administrative burdens have reached record highs. The traditional, reactive approach to revenue cycle management (RCM), where administrators play a game of whack-a-mole with revenue threats as they arise, can no longer keep pace with the industry’s complexity and evolution.
Most organizations rely on multiple fragmented vendors, manual and time-consuming processes, paper-driven workflows, and outdated technologies. It’s time for a new paradigm: a unified, “preactive” RCM strategy that prevents problems before they happen and delivers measurable results. As in health itself, prevention is the best cure for reimbursement woes.
The Current State of Healthcare Revenue Cycle Management
Revenue cycle management in healthcare is essential for capturing, managing, and collecting revenue—and for ensuring an organization’s financial viability. Like all areas of healthcare, however, RCM is rife with challenges.
Fragmented Vendor Ecosystems
Most healthcare organizations rely on multiple vendors for different RCM functions—patient access, documentation, coding, and denials. This patchwork approach leads to rising costs and lack of accountability, communication gaps and workflow delays, and increased risk of errors and revenue leakage. Further, significant investment of resources is required to maintain the disparate ecosystem of point solutions, and there is great danger that key information is lost between their siloes.
Operational Inefficiencies
The outdated, manual RCM processes and disjointed teams that organizations are accustomed to have created inefficiencies at every turn, delays in patient access, prior authorizations, and claims processing, and impacts on care. In fact, 93% of physicians say prior authorization causes delays in care, with 82% who say it sometimes leads to patients abandoning treatment, according to the AMA. Plus, more than 9 in 10 say prior authorization has a somewhat or significant negative impact on clinical outcomes. A majority of organizations use reactive approaches to address challenges and fix problems as they come up, which further drives inefficiencies.
Administrative Burden
With increasing volumes, regulatory demands, and evolving payer rules, clinicians and revenue cycle specialists alike have more administrative “chores” that take them away from their core work — patient-centric activities that improve outcomes, make for a better patient experience, and contribute to the bottom line. In fact, nearly 20% of clinical time is spent on tasks that could be delegated to non-physician staff or technology.
Rising Denials and Revenue Loss
Initial, subsequent, and final denials continue to rise, and for the past three years, they have held steady at 12%, according to Optum. Denials from commercial payers have seen an average increase of more than 20%, while those for Medicare Advantage have increased more than 55%. Inaccurate clinical documentation, provider eligibility issues, and coding errors are among the most common causes of denials, leaving organizations vulnerable to revenue leakage.
Workforce Shortages and Burnout
The revenue cycle hasn’t been immune to the staffing shortages that have touched nearly every other area of healthcare. In fact, 1 in 4 healthcare finance leaders say they need to hire more than 20 employees to fully staff their revenue cycle departments. Plus, more than 50% of CFOs say finding qualified revenue cycle staff has been more difficult. Increasing volumes and fewer staff increase the potential for errors and lead to stress and burnout, increasing rates of turnover. Additionally, even though over 80% of prior authorization appeals succeed, only 10% of them are ever appealed.
We see similar dynamics with claim denials and appeals, because there are not enough workers to recover these revenues. It is difficult to recruit, retain, and train staff to be effective at their tasks, especially in patient access, where a lack of specialized knowledge cannot command as high compensation as the rest of revenue cycle operators. Many different hats must be worn in these roles that typically preside over more than 50% of avoidable denials originating in tasks like pre-registration and financial clearance. When these operators get burned out and leave the organization, they take the critical knowledge that made them effective with them, disrupting revenue cycle operations.
The U.S. has a 30% shortage of medical coders.
From Reactive to Proactive to Preactive RCM
A reactive RCM model fixes errors after they occur. A proactive model anticipates some issues. But a preactive approach goes further: it eliminates the root causes of revenue cycle breakdowns before they can occur. For example, registration errors, benefits misalignment, and authorization issues are identified and resolved before a patient encounter, not after a denial.
Why This Matters:
- Prevents revenue leakage at the source
- Reduces administrative rework
- Improves patient and provider satisfaction
- Enables organizations to focus on care, not crisis management
The right technology is also essential. A single, integrated RCM platform eliminates vendor handoffs by providing full accountability across the access-to-payment lifecycle. Unified workflows and real-time analytics improve transparency and efficiency, while global and domestic human expertise enables around-the-clock coverage and cost optimization.
How IKS Health Delivers a Preactive, Unified RCM Workflow
IKS Health has rearchitected revenue cycle management solutions from the ground up, eliminating the patchwork of legacy tools and fragmented workflows. The result is a connected, AI-powered human-assisted model that begins the moment a patient seeks care and delivers measurable gains across access, reimbursement, and staffing efficiency. Instead of managing around inefficiencies, providers can finally optimize the revenue cycle because every step is connected, intelligent, and built to act before problems occur.
- Reinvented Patient Access
Our patient access solutions include eligibility and benefits verification, financial liability estimates, and prior authorization. Our Patient Engagement Hub is a digital tool that provides onboarding, behaviorally personalized omnichannel communications, agentic and generative AI, payment options, and more.
- Precise Clinical Documentation
The Scribble Suite is a flexible set of solutions that allows clinicians to document their work while ensuring accuracy, efficiency, and patient care. The suite includes various options such as ambient AI and live, human documentation that fit into unique workflows.
93% of hospital and health systems expect to adopt ambient AI tools at a moderate to deep level within the next 6 months.
- Audit-Ready Coding
Our medical coding solutions use GenAI, autonomous tools, and global human teams with deep domain expertise to ensure accurate, compliant, and audit-ready claims before submission—reducing denials and maximizing reimbursement. Our solution ensures a 98% accuracy rate. Our predictive analytics and automated pre-bill audits ensure charge integrity for every claim. Our solution performs comprehensive checks of revenue rules (charge reconciliation), compliance rules, and the payor’s propensity to pay.
- Preactive Denials Management
Our solution identifies and corrects the root causes of denials before submission, ensuring optimal clean claim rates. When denials are not preventable, however, we prioritize the quickest opportunities and those that are most likely to be recovered. Our solution continuously learns, optimizing the workflow and preventing these outliers from occurring in the future.
Impact in Action
For more than 600 healthcare enterprises, IKS Heath is a partner that is transforming the healthcare revenue cycle. In 2025, we were recognized as a leader by Black Book Research, landing the top spot in the first-ever AI-driven revenue cycle management category, as well as Clinical Documentation and Medical Coding, designations we have held for 12 and 3 years, respectively. Our proven solutions have been shown to:
- Reduce RCM costs by 42% and coding costs by 35%
- Improve patient access by up to 7%
- Lower front-end-related denials by 58%
- Deliver coding cost savings of $4.5M
- Achieve a net collection rate of up to 98%
Reimagine Your Revenue Cycle
With increasing volumes, persistent staffing shortages, and denials on the rise, now is the time for RCM leaders to rethink their current operations. IKS Health’s fully integrated revenue optimization suite transforms RCM from a patchwork of fixes to a seamless, future-proof solution.
Ready to see the difference? Connect with our experts and discover how a unified workflow can help you prevent revenue threats before they happen.