By Brian Robertson, Founder and CEO, VisiQuate
LinkedIn: Brian Robertson
LinkedIn: VisiQuate
History teaches us that in a conflict, the side with superior technology usually wins. Rifles versus bows and arrows, streaming versus VHS, GPS versus the paper map nobody could refold. The winner is almost always whoever adopted the new tool first.
Health systems are learning this the hard way in their disputes with health plans over claims denials. The plans were the first to point AI at the problem. They now evaluate and deny claims at a speed and volume no human team was built to match. The result is not that hospitals are outmatched on effort or intelligence. They are fighting by hand against a system the other side already automated, having spent their capital on the buildings and the EHR while the payers spent theirs on the machine now denying their claims.
And they are paying the price for it.
The latest Kaufman Hall report shows hospitals squeaking by on an operating margin of 1.9%, with rising denial rates quietly eating the difference. In 2025, amid a rising tide of prior authorizations, denials, and delays, hospitals spent $43 billion chasing payments from insurers. That is a staggering amount of money to spend getting paid for work you have already done.
Hospitals are fighting for their financial survival and, despite promises to the contrary, they should not expect an equally beleaguered insurance industry to ease up out of the goodness of its heart. The good news is that health systems can close the gap. They just need to know where the gap actually is.
Stop Playing Defense
Here is the counterintuitive part. The problem is not that hospitals lack AI. Plenty have bought it. The problem is that most of it has been bolted onto a broken foundation, which means it automates the mess faster instead of fixing it.
To improve revenue cycle management (RCM) through AI, organizations first have to change how they see the revenue cycle itself. RCM is no longer operational support. It is a core driver of enterprise strategy, corner office and all.
A Decade of Duct Tape
For 10 years, health systems have been handed a revenue cycle stitched together out of bolt-on tools, one-off integrations, and vendor promises that aged like milk. Nobody chose the duct tape. It accumulated, one urgent fix at a time, until the seams became the system.
The trouble is that fragmentation has a cost, and no amount of clever technology repeals it. Solve one department’s headache and you have simply moved the aspirin. Data that cannot travel cannot be trusted, and a revenue cycle you cannot trust is one you cannot steer by.
Garbage In, Garbage Out
This is where a lot of AI ambition quietly goes to die. Point a sophisticated model at bad, fragmented data and you do not get insight. You get the same bad answers, delivered with more confidence and at greater speed. AI is happy to automate your worst habits. It will not tell you they are not worth keeping.
A trustworthy foundation is not the glamorous part of the story, but it is what makes every other part possible. Clean, connected, governed data is what turns AI from an expensive guess into a dependable certainty.
Automation Was Just the Warm-Up
Early RCM automation was about doing the same tasks faster. Useful and industry-changing, but a warm-up. The real shift is from automating tasks to orchestrating them, a system less like a pile of gadgets and more like a team that actually shows up to the same meeting.
That means capabilities that work together rather than in isolation: reading a denial, understanding why it happened, assembling the appeal, and learning from the outcome so the next claim is cleaner before it ever goes out the door. Not a roster of tools you manage, but a coordinated agent ecosystem that manages the busywork for you and only surfaces those tasks that need human intervention.
Making It a Fair Fight
The asymmetry that put hospitals on the back foot is not permanent. The payers got a head start because they aimed AI at a clear target and built on a foundation that could support it. Health systems can do the same, and they hold an advantage the plans do not: they actually want the claim paid.
Build the foundation, and the arms race stops being lopsided. The goal was never to out-gadget anyone. It was to make it a fair fight, and then to win it on the merits.