On any given day for a professional in the healthcare provider space, the balance between time and quality can be a struggle. Demands on provider time have been growing steadily year after year due to factors including an aging population and more sophisticated payer denial tactics. In fact, according to the American Journal of Managed Care, insurance claim denials surged by 16% from 2018-2024, with some providers averaging 20% to 30% of claims denied annually. It’s a generally accepted fact that payer denials are at an all-time high, with rates still increasing. But, while denial rates are way up, evidence shows that a significant portion of those denials are overturned on appeal, giving hospitals the chance to earn proper reimbursement within a later part of the revenue cycle. The administrative burden of seeking proper reimbursement has fallen to hospital staff and administrators, leading to a crisis in hospital care.
However, with crisis comes innovation. Dr. Jerilyn Morrissey, Chief Medical Officer at CorroHealth is among the thought leaders attempting to bridge the gap between clinical care and reimbursement. In her role, Dr. Morrissey helps providers navigate the complexities of the modern healthcare industry, providing support and ensuring her clients manage payer interactions that compliantly achieve revenue integrity.
Over the years, Dr. Morrissey has witnessed a shift in hospital administration strategies to combat the challenging payer landscape. “Almost everybody in the organization feels the pressure of these increasing denials, and almost everybody is working really hard to innovate and streamline and have a beneficial impact,” Dr. Morrissey shares. “The struggle comes when these efforts are not coordinated or organized under an overarching strategy.”
The hospital revenue cycle — especially the time between discharge and billing — is long, complex, and often siloed between professionals in UM, CDI, and denials management, making it a prime space for gaps, irregularities, regulatory missteps and other potential payer interruptions. Building a cohesive strategy and workflow between them can be a crucial operational shift to solving the problems of insufficient reimbursement.
So, how might one do that? “At CorroHealth, we look at UM, CDI and Denials Management as three legs of the same stool,” explains Morrissey. “All efforts from all three departments have to be focused on the same strategic goals, not individual team or operational metrics.”
It’s typical in a hospital setting that the KPI’s per department have been over-simplified or pointed towards single-focused success. Furthermore, the decision-making data that hospitals consider their north stars may actually be misleading. Dr. Morrissey explains that “it’s not the denial rate that matters, but rather it’s the denial rate by payer, by midnight, and by the number of touches we are expending to prevent or respond to that denial at each level that has to come into the equation as we are striving towards a solution.”
One simple way to solve the issue might be to hold regular inter-departmental meetings. “When you can have these teams together, all at the table and all speaking the same language and all aligned on the same outcomes, that’s when we start to see meaningful improvement.”
Though simple, the process is not always easy. Many organizations, drowning in their administrative burdens, succumb to what seems like a “quick fix.” Dr. Morrissey warns against that, saying “all too often I see hospitals and administrators try to take a one-size-fits-all response to these issues. We try to boil the ocean with the intervention and the result is we fail over and over again.”
A targeted approach, rather than large broad-stroke solutions, may be the secret to improving your hospital’s bottom line. And already Dr. Morrissey has seen this strategy work among her list of hospital clients. “Twenty percent of your volume will account for eighty percent of your issues,” she reveals. “If you can have precise interventions and track and monitor results with a continuous feedback loop, you will see improvements.” Technology has entered the conversation — but it’s not a silver bullet. “It’s not just about using AI,” says Dr. Morrissey. “It’s about using it well.” In today’s healthcare environment, hospitals face intense pressure to document quickly and accurately — despite increasing complexity, mounting regulatory requirements, and limited time. Many hospitals are beginning to explore how AI can ease documentation demands by surfacing only the most relevant information — helping providers capture what matters most, the first time, without adding to their administrative burden.
The challenge, Morrissey explains, is not the absence of data, but knowing how to act on it. “Many hospitals are still chasing legacy metrics or drowning in dashboards that don’t drive decisions.” Cutting through the noise by combining clinical expertise with advanced automation, delivering the right insight at the right moment to improve DRG accuracy, documentation quality, and ultimately, revenue integrity has the greatest impact.
These incremental improvements often spark broader innovations in documentation, workflow, and denial prevention — creating a ripple effect that can transform both clinical and financial outcomes. As Dr. Morrissey notes, this kind of targeted, cross-functional approach may be the winning game plan hospitals need now more than ever. To explore smarter strategies for tackling documentation and denials, visit www.corrohealth.com.
The editorial staff had no role in this post's creation.