Why are healthcare claim denials expected to remain a significant challenge in 2025?

Claim denials remain a major issue in 2025 due to increased payer scrutiny, changing reimbursement rules, and system complexity. With nearly 12% of claims denied and over $262 billion affected annually, providers face delays, high rework costs, and substantial unrecovered revenue.

How are RCR|HUB Business Partners helping providers reduce denials and recover revenue?

RCR|HUB connects providers with trusted partners like Sunbelt Health Partners, The SSI Group, and FairCode, who use technology and clinical expertise to address denial causes, improve appeals, and boost reimbursement through tailored strategies and outsourcing support.

What role does front-end automation play in preventing denials?

Front-end automation helps prevent denials by catching errors before claim submission. Tools like payer-specific edits, eligibility checks, and pre-bill validations improve clean-claim rates and reduce the burden of reworking denied claims.

Which types of denials are most challenging to resolve, and how are specialized partners addressing them?

Challenging denials like DRG downgrades, bundling conflicts, and medical necessity issues require clinical and legal expertise. Partners such as Sunbelt Health Partners and J2 Integrity Solutions use attorneys, clinicians, and coders to analyze and appeal these complex cases effectively.

How does a holistic approach to denial management improve overall revenue cycle performance?

A holistic denial management strategy integrates prevention, monitoring, and appeals across the revenue cycle. Companies like PATHS, LLC and Signature Performance align departments, reduce redundancy, and build sustainable revenue protection frameworks.

How do companies like Health Payment Systems (HPI) influence denial rates through patient billing improvements?

HPI improves patient billing clarity with consolidated statements, reducing misunderstandings that lead to denied claims. Clear communication helps patients fulfill responsibilities, decreasing rejections from non-compliance or confusion.

What benefits does physician-led coding bring to denial management efforts?

Physician-led coding, like FairCode's model, ensures documentation supports claim codes and meets payer standards. This approach improves coding accuracy, reduces denials, and strengthens audit readiness through clinical oversight.

Why is it important for healthcare leaders to treat denial management as a strategic initiative?

With denial volumes rising, leaders must view denial management strategically. Investing in tools, partnerships, and cross-departmental alignment reduces costs, improves data usage, and builds long-term revenue resilience.

How does RCR|HUB simplify the process of finding the right denial management partner?

RCR|HUB offers a centralized platform to compare verified partners, filter by expertise, and access denial-related insights. It streamlines vendor discovery, helping providers connect with the right partners faster and more confidently.

What long-term impact can effective denial management have on healthcare organizations?

Effective denial management reduces recurring errors, lowers operational costs, and strengthens payer relationships. Over time, this leads to improved compliance, stable revenue, and better support for patient care delivery.

Overcoming Denials in 2025: Trusted Partners Helping the Revenue Cycle Community

Oct 23

Written By Matt Stephens

In 2025, denials remain one of the most costly and persistent challenges in healthcare Revenue Cycle Management. U.S. healthcare organizations lose approximately $20 billion annually through direct revenue loss, administrative appeals, and delayed cash flow. Industry data shows that more than $262 billion in claims are initially denied each year, while about 63% of those denials are appealed and sometimes recovered. The remaining $20–$25 billion in unrecovered revenue and operational waste weighs heavily on hospital and health system margins.

With denial rates climbing to nearly 12% on average, and each denial costing $25–$50 per rework, denial management is no longer a back-office function. It’s a strategic priority for CFOs, Revenue Cycle leaders, and patient access teams across the country.

At RCR|HUB, our CommUnity connects healthcare providers with trusted Business Partners who bring technology, expertise, and hands-on support to help reduce denials, streamline appeals, and recover lost revenue. Below, we highlight several companies listed on RCR|HUB that are making a measurable difference.

1. Sunbelt Health Partners

Website: sunbelthealthpartners.com
Focus: Attorney- and Clinician-Led Denial Resolution

Sunbelt Health Partners combines legal, clinical, and payer expertise to address complex denials across all categories , from DRG downgrades and medical necessity to bundling and authorization issues. Their denial resolution services are led by attorneys and clinicians with over 30 years of experience, offering unparalleled insight into payer behavior and contract interpretation.

Why It Matters:
Sunbelt’s legal and clinical teams deliver high success rates on complex appeals, particularly those requiring deep medical or contractual review. Their tailored solutions allow hospitals to define engagement scope while improving cash flow and compliance.

2. The SSI Group (thessigroup)

Website: thessigroup.com
Focus: Denial Prevention Through Front-End Automation

The SSI Group tackles denials before they happen. With one of the largest libraries of payer-specific edits (covering more than 4,500 payers and one million combinations), SSI’s claims management tools deliver unmatched clean-claim rates and reduce initial denials at the source. Their integrated platform also includes denial tracking, root cause analysis, and appeals support.

Why It Matters:
SSI’s strength is in front-end denial prevention, helping providers submit cleaner claims, identify recurring issues, and reduce costly rework.

3. J2 Integrity Solutions

Website: j2is.com
Focus: Clinical and Coding Denial Resolution

J2 Integrity Solutions specializes in clinical and coding denials, offering a data-driven approach to identify root causes and prevent repeat errors. Their consulting services help teams strengthen documentation, coding accuracy, and workflow efficiency.

Why It Matters:
Hospitals struggling with documentation-related denials benefit from J2’s combination of education, analysis, and hands-on remediation, turning short-term recovery into long-term prevention.

4. PATHS, LLC

Website: hcpaths.com
Focus: Comprehensive Revenue Recovery and Denial Management

PATHS integrates denial management into its broader suite of RCM services, providing full-cycle support that includes billing, follow-up, claims scrubbing, and appeals. Their flexible programs are customized to each client’s needs, delivering measurable financial improvement.

Why It Matters:
For hospitals seeking one partner to manage multiple revenue cycle functions, PATHS offers a holistic outsourcing model that embeds denial resolution into every step of the process.

5. Health Payment Systems (HPI)

Website: hpiinc.com
Focus: Patient Billing & Financial Clarity

While not a denial management company in the traditional sense, HPI helps reduce patient-related denials by improving billing clarity and patient engagement. Their consolidated billing solutions simplify payments and reduce confusion that can lead to disputes and delays.

Why It Matters:
By tackling denials at the patient communication level, HPI supports cleaner revenue cycles and improved patient satisfaction.

6. FairCode

Website: faircode.com
Focus: Physician-Led Coding Accuracy

FairCode’s physician-led coding model helps hospitals capture accurate reimbursement and defend against denials caused by clinical coding gaps. Their expert team ensures documentation fully supports coded claims, improving both revenue integrity and compliance.

Why It Matters:
Organizations working to close documentation gaps and improve DRG validation can rely on FairCode’s clinical expertise to reduce coding denials and enhance audit readiness.

7. Signature Performance

Website: signatureperformance.com
Focus: Strategic Denial Management and Operational Support

Signature Performance blends technology, analytics, and deep RCM experience to help organizations identify and eliminate root causes of denials. Their strategic approach aligns processes across the revenue cycle, bridging gaps between front-end operations and back-end collections.

Why It Matters:
Their consultative, enterprise-level solutions are ideal for organizations seeking to standardize denial management across multiple facilities or departments.

How the RCR|HUB Community Helps

Each of these companies is part of the RCR|HUB Community, a digital platform built exclusively for U.S. healthcare Revenue Cycle teams. Through RCR|HUB, providers can:

Compare verified Business Partners across categories
Research solutions tailored to denial management
Connect directly with companies that align with their needs
Stay informed with blogs, education, and industry news

With denials costing the U.S. healthcare system $20–$25 billion annually, RCR|HUB makes it easier for teams to find the right partners and reclaim lost revenue.

Visit RCR|HUB.com to explore more companies offering Denial Management Services, compare solutions, and strengthen your organization’s revenue cycle.

Together, we’re helping the RCM Community turn denials into dollars and improving access to care in the process.

Sources:

Change Healthcare, 2024 Revenue Cycle Denials Index
HFMA Insights, 2024 Denials Benchmarking Report
MGMA Stat, Denial Management Trends 2024
Advisory Board, Revenue Cycle Priorities 2024–2025

Matt Stephens

Chatham Oaks was founded after seeing the disconnect between small business owners and the massive marketing companies they consistently rely on to help them with their marketing.

Seeing the dynamic from both sides through running my own businesses and working for marketing corporations to help small businesses, it was apparent most small businesses needed two things:

simple, effective marketing strategy and help from experts that actually care about who they are and what is important to their unique business.

https://www.chathamoaks.co