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Build a Stronger Bottom Line with our Hospital Budgeting Toolkit 

Budget season can put health system leaders in a difficult spot. Costs must come down and every dollar has to be justified. But with denials rising, payer demands intensifying, and patient needs growing more complex, no option feels like the right one.

As Dr. Jerilyn Morrissey, Chief Medical Officer at CorroHealth, explained in a recent webinar, many organizations are asking the wrong question: “How can we spend less?” The better question is: “How can we manage costs strategically while protecting revenue?“   

To move forward, hospitals need financial models designed, not just to reduce expenses, but to sustain growth over the long term. Organizations must look to re-think annual strategies to improve financial performance in 2026. Additionally, implementing a budgeting checklist and assessing denials can safeguard financial sustainability and preserve high-quality patient care.  

As health system leaders prepare for the year ahead, consider the following:  

 

  • Beware of “denials avoidance”: Many hospitals pursue a “denials avoidance” strategy by downgrading patients to observation status. On paper, it lowers denials rates. In reality, it means giving up millions in appropriate and compliant reimbursement and ceding ground to payer tactics.  
  • Invest in documentation integrity: Typically, about 60% of contracted payments flow in without issue. The remaining 40% depends directly on how well UM, CDI, denials management, and payer escalation are executed. Without steady, intentional investment in these functions, many hospitals would be at risk. With targeted, ROI-focused investments, however, that gap can be closed, bringing hospitals much closer to capturing the full value of their contracts.    
  • Break the silos in the revenue cycle: UM, CDI, and denials teams often operate in silos with disconnected metrics and limited communication. Dr. Morrissey posted a simple litmus test: Do your directors of case management, CDI, and appeals even know each other’s phone numbers? If not, chances are your hospital is leaving revenue on the table. When these functions work together, the impact multiplies.  
  • Push back on payers: Even the strongest UM, CDI and denials program can’t eliminate payer friction. To protect both today’s reimbursement, tomorrow’s revenue streams and the patient, hospitals must be prepared not only to defend individual claims but also to escalate disputes strategically.  

CorroHealth Investing Wisely Budgeting Toolkit 

Annual Budget Planning Checklist
  • Break the silos in the revenue cycle: Plan regular multi-disciplinary meetings 
  • Spend money wisely: Invest in UM, CDI and Denials Management solutions 
  • Couple technology with clinical intelligence 
  • Push back on payers with escalation strategies 
Denials Assessment 

The following framework will allow health systems to log and analyze denials data and intelligence, assess your denials and contribute to an effective management and escalation strategy. 

Step One: Categorize (837/835)  

Hard Denials 

  • No Authorization / NOA / Referral 
  • Medical Necessity / LLOC 
  • DRG Downgrades 

Soft Denials 

  • Billing Errors 
  • CCI / Coding 
  • COB / Eligibility 
  • Information Requests 
  • Non-Covered Services 
  • Timely Filing Expired 

Step Two: Profile 

Create a complete repository to include all denials, including those not captured on the 835.  Additionally, layer in the following: 

  • Root-cause Identification 
  • Appeal Strength Identification 
  • Denial Source 
  • Timely Filing Period 

Step Three: Strategize

 

  • Use resources based on the denial root-cause 
  • Easy identification of strong appeals for payer escalation / arbitration / litigation 
  • Denial rates with enhanced accuracy 
  • Finding target areas for denial reduction focus 

The pressures on hospitals are not abating. Margins will remain tight, denials will continue to rise, and the Medicare Advantage population will keep expanding. But hospitals are certainly not powerless. By rethinking their approach—combined with the right resourcesthey can safeguard financial sustainability while keeping patient care at the center. 

Additional Resources to Consider: 

How Payers Keep Denials Rates High, and What to Do About it

How Payers Keep Denials Rates High, and What to Do About it

Level the Playing Field: How Payers Keep Denial Rates High, and What to Do About itMore than 25 years ago, on a day like any other, when Dr. Jerilyn Morrissey (now Chief Medical Officer at CorroHealth) was just a new physician and documentation was a pen-to-paper...

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Why Cutting Costs Alone Won’t Save Hospitals | CorroHealth

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Why Cutting Costs Alone Won’t Save Hospitals Budget season can put health system leaders in a difficult spot. Costs must come down and every dollar has to be justified. But with denials rising, payer demands intensifying, and patient needs growing more complex, no...

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PULSE Coding Automation Technology™ by CorroHealth leverages cutting-edge GenAI and commonsense reasoning to solve the complexities of clinical documentation. By partnering with researchers at The University of Texas at Dallas (UTD), CorroHealth has enhanced PULSE’s capabilities, achieving 7X productivity gains, faster client onboarding, and unmatched coding accuracy. Discover how PULSE transforms medical coding and financial outcomes for hospitals.

👉 Explore the breakthrough or book a demo today!

Strategic Escalation in the Face of Rising MA Plan Denials

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Strategic Escalation in the Face of Rising MA Plan Denials  Originally published on Becker's Hosptal ReviewRelationships between providers and Medicare Advantage (MA) plans have become more strained as payers aggressively deny claims. To ensure providers' financial...

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