Winning the Denials Battle

How top systems leverage data & documentation for financial and patient-centered gains

Originally published on Becker’s Hospital Review.

With rising denial rates and increasing complexity in reimbursement processes, healthcare providers are finding it more difficult than ever to optimize their financial outcomes — with documentation often at the core of these challenges. 

Research shows that nearly half of claims denials (46%) stem from missing or inaccurate data, while close to one-third (30%) result from incomplete or inaccurate patient information. In response, many hospitals and health systems are rethinking their documentation strategies with a renewed focus on precision, aiming to reduce denials and safeguard financial integrity. 

These were among the overarching themes during the 2025 Driving Results Through Documentation summit, hosted by Becker’s Healthcare in collaboration with CorroHealth. 

Major Themes

Documentation drives revenue — but places a significant burden on clinicians

Documentation captures every clinical observation, decision and intervention, and is needed at every stage of the revenue cycle. As Jerilyn Morrissey, MD, chief medical officer, CorroHealth, noted, clinical documentation is the “workhorse” of the revenue cycle.

While the timeliness, accuracy and consistency of information captured in patient records are known contributors to better patient outcomes, documentation remains a major pain point for clinicians. Providing all of the necessary documentation is often onerous, and many providers revert to cutting and pasting information into the EHR system.

Alon Weizner, MD, chief medical officer and senior vice president of revenue cycle at Mount Sinai Medical Center in Miami Beach, Fla., reiterated that documentation must be an accurate reflection of interactions among clinicians, patients and families — and this isn’t possible when doctors simply cut and paste information. “We’ve been very aggressive at flagging and talking with clinicians about cutting and pasting. We implement action plans for people who don’t seem to listen to us,” he said.

These shortcut tendencies highlight the importance of streamlining documentation. According to Geoff New, EdD, senior vice president at CorroHealth, healthcare organizations must take a closer look at the documentation tools providers are using.

“Sometimes, physicians aren’t even aware that their documentation isn’t accurate,” he said. “By the time it makes it to the coding and billing area or the CDI [clinical documentation improvement] department, the information is wrong. Yet, physicians have done the best they can.”

Culture change is a key lever for improving clinical documentation

One of the core challenges with clinical documentation is a fundamental lack of understanding among many clinicians about its broader impact. Without clear context, documentation can feel like a burdensome administrative task. It’s up to hospital and health system leaders to bridge that gap — clarifying how timely, accurate documentation directly influences quality scores, clinical outcomes and reimbursement.

Pittsburgh-based UPMC, for example, has focused on changes to the two-midnight rule, which encompass Medicare Advantage. To reinforce the need for better documentation, the organization incorporated a nudge at the bottom of every history and physical (H&P) form, encouraging providers to document why they think a patient will require two consecutive overnight stays in the hospital. “That’s worked beautifully, but we had to connect it to the ‘why’ or else it’s just chart bloat,” Amanda Lenhard, MD, vice president of clinical care coordination and hospital medicine at UPMC, said.  

Praising physicians for excellent documentation is another way to shift the culture. Once a week, Dr. Lenhard strives to send “sparkle emails” to providers, CEOs and chief medical officers. “It costs nothing to tell them how awesome they are. It might motivate them the next time they see a patient to write why they needed to be in the hospital and to include ‘present on admission,'” she said.

But improving documentation isn’t just a hospital issue. Olaf Faeskorn, vice president of revenue cycle at SGMC Health (Valdosta, Ga.), noted that health systems need to do a better job of bringing documentation initiatives together across the enterprise — including professional and clinical care settings.

Documentation improvement efforts are shifting upstream

Traditionally, CDI has lived in the coding and revenue cycle space, following patient discharge. However, with technologies like ambient listening and mobile devices, providers can accurately document upstream at the point of care. In addition, AI tools in the EHR can summarize information with a focus on medical specialties. This enables physicians to quickly review charts and spend more time with patients.

Geoff New explained that technology also enables healthcare organizations to educate clinicians on the job about documentation best practices. “Providers are aggravated by the number of queries they get about documentation and the lack of feedback until several days later,” he said. “With technology solutions, we can educate them as they document and we can teach in small bites.”

Healthcare leaders recognize that denials management has become an arms race that pits payers and providers against one another. In response to the growing volume of payer denials, some organizations revert to a passive approach, while others feel compelled to appeal everything — which results in significant administrative hurdles and payment delays.

While denials can’t be eliminated entirely, hospitals and health systems must concentrate on what they can control in the revenue cycle. “Focus on the easy-dollar things first, like meeting timely filing dates, handling authorizations or submitting medical records,”. New said. “Payers bank on providers not submitting appeal letters.”

He also advised organizations to keep in mind that once denials occur, there are still many actions that can be taken to affect the financial fate of those cases. Examples include appealing or rebilling services as outpatient.

Managing denials manually on a case-by-case basis is common, with nearly 50% of providers still reviewing denials manually and only 10% indicating they have a fully automated process. For the best results, organizations must optimize how they handle denials. 

“The choices you make in denials handling have a huge impact on how the financial story works out,” Luisa Contreiras, president of CorroHealth, said. “Organizations need scalable ways to deal with denials and that means relying on automated algorithms.”

Data-driven denials management turns a defensive task into a strategic advantage

By establishing a formal, algorithm-driven denial management process, hospitals and health systems can ensure they take the appropriate action for each denial.

CorroHealth’s denials optimization scoring engine identifies the best course of action for every denial. This can generate millions of dollars in additional payments for a healthcare organization, while minimizing the number of days in outstanding accounts receivable. CorroHealth’s data-driven solutions also liberate staff from low- or no-value activities, so they can focus on the highest-value denials work.

“If an organization is very targeted and moves away from a subjective, case-by-case analysis to an approach that is algorithmically based, it yields the best financial results,” Sam Dominik, senior vice president at CorroHealth, said.

CorroHealth’s analytics and monitoring also enable organizations to track variances between the optimal action for a denial and the action that was actually performed. To mitigate negative denials behaviors in the future, CorroHealth’s data-driven payer escalation framework flags issues at the contract level, so hospitals and health systems can negotiate guardrails and protections.

“We provide clients with actual data showing that payers are eroding contracted revenue and that rate increases aren’t going to make up for it,” Ms. Contreiras said. “Healthcare organizations can take that data to payers and use it as a weapon.”

Denials are an inescapable part of today’s healthcare landscape. Organizations that fail to adapt — continuing to manage denials with outdated or reactive approaches — risk falling behind. To stay competitive and protect revenue, hospitals and health systems are increasingly embracing scalable strategies that prioritize timely resolution and defend their financial interests.

“Fighting for the revenue you are entitled to every step of the way will always yield better results than acquiescing at any step in the process,” Mr. Dominik said.