By Beth Friedman, FACHDM, Sr. Partner, FINN Partners
LinkedIn: Beth Friedman
LinkedIn: FINN Partners
Host of FINN Voices
Over 2,000 revenue cycle and finance professionals met in Denver last month to attend the Healthcare Financial Management Association (HFMA) Annual Conference. Facing Medicaid and Health Insurance Marketplace uncertainty, the leaders explored new ways to remain resilient from association leaders, technology futurists, health system peers, and a political analyst.
Four days and dozens of educational sessions later, I walked away from #HMFAAnnual inspired by these hospital and health system financial leaders. Here’s what they had to say.
Payer Audits and Denials Remain Entrenched Across Revenue Cycle Teams
Payer audits and denials remain a deeply rooted, persistent challenge across all revenue cycle departments, with no easy solution in sight. The volume of these actions continues to escalate as payers increasingly leverage new AI tools to scrutinize claims, claw back reimbursements, and maintain a strategic advantage over hospitals and health systems. This perennial problem was the central theme of a recent HFMA’25 session.
Panelists from MRO and Wellstar Health System shared their focused strategies for keeping pace with payers. Their winning approach emphasizes identifying, preventing, and effectively managing audits. Proven tactics include centralization, cross-departmental alignment, collaborative efforts, and automation.
Four Best Practices from the Panel:
- Centralize the receipt of payer inquiries and assign specific codes for each within your Electronic Health Record (EHR). This ensures a single point of entry and organized tracking.
- Optimize workflows to automatically route these cases to specialized denial prevention and management teams.
- Foster inter-departmental collaboration to develop and continuously refine best-practice workflows. This iterative process allows for ongoing improvement.
- Act as proactively and collaboratively as possible to mitigate reimbursement risk. Early intervention and teamwork are crucial.
According to Alicia Spratt, FHFMA, AVP of Revenue Cycle Operations at Wellstar, “Denial prevention isn’t a one-time effort, nor does it occur in a single department; it happens across the entire revenue cycle.” Spratt emphasizes that proactive denial prevention is the key to success. She stressed the necessity of automating manual spreadsheets and tracking, advocating for real-time insights accessible to all teams.
Shawn Armbruster, MHA, RHIA, Executive Director of Coding at Wellstar, added that “reviewing coding discrepancies through real-time data insights has significantly benefited Wellstar.” While provider organizations will always contend with payer denials and high audit volumes, automated workflows enable the review of more cases with fewer staff resources, ultimately improving compliance and safeguarding revenue. Wellstar’s success serves as a compelling example of this approach in action.
AI Futurist Explores Unmetered Intelligence
My first keynote session featured AI futurist Zack Kass. Kass illuminated four phases of technological innovation, from today’s AI-enhanced applications to tomorrow’s era of unmetered intelligence.
Machine intelligence is rapidly advancing, with capabilities doubling every seven months. Soon, research will be commoditized, and autonomous agents will empower everyone to be an expert. Browsing the internet will become obsolete as devices transition from PCs and phones to rings, watches, and credit cards.
In this new era, human competition will shift from cognitive brilliance to soft skills and relationships. However, Kass also highlighted concerns such as dehumanization, a phenomenon already observed in younger generations, along with the risks of bad actors and job displacement.
Despite these challenges, Kass offered a hopeful outlook on how unmetered intelligence can reduce suffering and increase joy through:
- Expansion of human potential. Expect dramatic productivity gains and major scientific breakthroughs, like quantum fusion.
- While healthcare, education, and housing face inflation, other sectors will see continued deflation as technology reduces operational costs. Removing outdated policies and regulations can further accelerate technological advancements in these areas.
- We will gain more time and live longer, emphasizing the need for deliberate relationships with our devices, choosing interactions beyond just our phones.
Kass’s ultimate advice for the audience was to embrace adaptability as a core strategy. As everything changes, businesses must be designed to keep pace. He stressed the importance of learning how to learn, deeming it the essential energy for the future. Finally, Kass encouraged attendees to design professional futures around capabilities that AI cannot replicate, as the computational power of our brains becomes less critical.
Payer Management Sessions Draw Biggest Crowds
Educational sessions that focused on keeping up with payers were standing-room-only at HFMA’25. This included several sessions focused on the use of analytics and AI across the revenue cycle. I also discussed revenue cycle automation with four women in healthcare revenue cycle. Here’s their advice.
Dawn Crump, MA, CHC, LSSBB, Vice President, Revenue Integrity Solutions, MRO: “AI must be explored as a new technology tool to keep pace with payers and achieve operational efficiency in the revenue cycle. However, provider organizations are still responsible for the outcomes and regulatory compliance, regardless of the technology used. Look for trusted and verified solutions backed by clinical knowledge and expertise.”
Margaret C. Martin, JD, Managing Director, Revenue Cycle Transformation, Tegria: “When considering revenue cycle automation, start by identifying the specific functionality you need and ensure your core technology, particularly your EHR, is fully optimized. Look for solutions that are scalable and flexible enough to evolve alongside your organization’s needs.”
Kim Waters, MBA, CDH-E, CHFP, Principal Advisor, CereCore: “Take time to conduct a thorough analysis of your revenue cycle technology stack before adding a new AI solution. Be sure to focus on long-term solutions versus short-term fixes. AI should not be implemented if the organization has not first established a simplified, stable IT infrastructure. Look for technology that delivers meaningful operational improvements in the revenue cycle.”
Merideth Wilson, MBA, General Manager, TruBridge: “The use of AI to streamline claims and denial management is a top area of focus for our hospital customers and internal teams alike. Revenue cycle operations will continue to become smarter and more efficient, shifting workers’ focus from tactical to strategic functions over time.”
Negotiations with Service Vendors and Health Plans Get Data Boost
Two separate sessions discussed the value of data insights for better negotiations with service vendors and health plans.
John Dockins, MBA, Executive Director of Sourcing and Vendor Management at the Cleveland Clinic, presented the organization’s journey to save money and time through smarter procurement of non-clinical goods and services. Also known as “indirect spend,” Dockins shared that these expenses can account for over 30% of net patient revenue, yet their oversight is often decentralized and understaffed. Dockins recommends finance executives “look outside the healthcare industry to find accurate benchmarks for non-clinical goods and services. For example, elevator maintenance is elevator maintenance. Snow removal is snow removal.”
Dockins uses data insights from LogicSource to fuel his savings. According to Dockins, “It’s fascinating what you learn when you compare your spending to other local businesses like Walmart, Target, and Mike’s Muffler.”
Dilpreet Sahota, CEO of Trek Health, joined Scott Ellsworth, a former health plan executive, to explain the need for data transparency in payer negotiations. According to Ellsworth, providers have more leverage than they realize, but they need data. Without data, payers retain the upper hand in contract talks. Here are five contracting realities shared during the session:
- Providers have the patient-loyalty advantage over payers. If there is no patient network, the payer has no business.
- Payers don’t negotiate in good faith. They use data, and providers must also use data.
- Payers count on providers caving at the eleventh hour.
- Payers’ data is deeply gamified.
- Providers leave an average of 3-7% of revenue on the table during payer negotiations.
Sahota explained how AI-powered contract intelligence uncovers hidden opportunities for health systems. Insights such as rates across other hospitals in the region, rates by zip code, and more can be specifically tailored for managed care and finance teams. The power of data is undeniable.
Vanderbilt’s Direct-to-Employer Bundles: A Value-Based Success Story
Dr. Ruchika Talwar, Medical Director of Offices of Episodes of Care, Population Health, at Vanderbilt University Medical Center (VUMC), led an impressive session at HFMA’25, showcasing a $5M money-saving strategy: direct-to-employer contracting for payment bundles. These bundles range from maternity care to orthopedic surgery.
VUMC collaborated with Nashville-area employers to identify the most crucial medical episodes for their employees. This program, “MyHealth Bundles,” adopted a “listen first” approach to value-based care.
Working alongside employers, VUMC clinicians, and an actuarial team, the organization developed “MyHealth Bundles. These bundles allow employers to budget more accurately and help patients avoid surprise bills. Importantly, the bundles also accommodate more participants by including high-risk patients as built-in outliers.
“Physician participation was essential for the program,” states Dr. Talwar. Physicians helped design the bundles and are deeply intertwined in the outcomes, not just the billing codes.
Outcomes show promising results: fewer unnecessary surgeries and faster patient recovery periods. VUMC plans to continue utilizing direct-to-employer contracting and health bundles to advance its value-based care initiatives.
HFMA’25 Concludes with Timely Insights from a Washington Insider
Amy Walter, Publisher and Editor-in-Chief of the Cook Political Report, delivered the final keynote. Walter highlighted the widening political gap stemming from diverse and complex news sources, which create differing problems and perspectives. She noted that active news consumers tend to lean Democratic, while passive enthusiasts more strongly support President Trump.
Walter predicted that after the “Big Beautiful Bill” passes (Congress passed it on July 3rd, 2025), Republicans will likely reframe its messaging. For instance, Medicaid cuts might be positioned as a way to combat fraud, waste, and abuse. However, 64 House Republicans represent districts with the highest share of Medicaid recipients, meaning these areas could be disproportionately impacted by cuts and ACA changes.
Comparing the two parties, Walter offered predictions for the 2026 mid-term elections and the 2028 presidential race, noting the historical trend of the party in power losing seats during mid-terms. Her advice to healthcare executives included:
- Expect the unexpected, preparing for significant events but only minor political shifts.
- Remain optimistic and adaptive, recognizing American resilience.
- Embrace the United States as a dynamic, evolving 250-year experiment.
- Stay engaged; it’s a national duty.
- Remain humble, yet confident in your decades of proven healthcare experience.
2026 in National Harbor: See You There
In healthcare, we’ve faced uncertainty many times before and we’ll face it again. Revenue cycle and finance executives will adapt and succeed with new technologies and community partnerships as their foundation for the future.
I’ve thrived in the health industry for 40 years and I remain eager to learn what’s around the next turn. Resilience is our mutual superpower.