EnableComp CEO Frank Forte makes the case that complex claims are one of the most valuable, and most misunderstood, assets on a health system's balance sheet in his latest Health IT Answers article, Complex Claims Are a Strategic Asset. Treating Them Like a Vendor Decision Is Costing You Millions.
Forte opens with a Midwest CFO facing what looked like an easy win: consolidate complex claims onto a single generalist RCM platform and save roughly $400,000. The catch was the number no one had run. Walking away from the complexity specialist would cost the system close to $25 million in revenue a generalist would never recover, about 60 times the projected savings.
From there, Forte explains why a blended recovery rate can hide weak performance on the hardest claim categories, why a workers' compensation or out-of-state Medicaid claim behaves nothing like a routine one, and why switching vendors mid-underperformance tends to compound the problem rather than fix it. He closes with a practical framework for finance leaders: pull complex claims out of the blended rate and benchmark each category on its own, measure total yield rather than fees and clearance speed, and trace denials back to their root cause before reaching for a new contract.
Read the full article on Health IT Answers.