Resources

What is a zero balance review? (And why your hospital is leaving money behind)

Your AR dashboard looks clean. Denials are trending down, follow-up queues are current, and thousands of accounts have closed at zero. That's the problem. A closed account and a correctly paid account are not the same thing. Some of what your team marked "resolved" was actually written off, adjusted in error, or paid by the wrong payer.  For many providers, once […]

How to appeal a DRG downgrade appeal: A step-by-step guide

Payer denials are not new to revenue cycle leaders. But DRG downgrades represent a particular kind of threat: one that often arrives quietly, weeks after discharge, buried in a post-payment adjustment. By the time your team catches the downgrade, the revenue has already walked out the door. This guide walks through the DRG downgrade appeal process from triage to escalation, […]

The cost of claim denials: Hospital revenue leakage statistics CFOs should know

You don't need to be convinced that denials are a problem. You're living it. In a recent survey of hospital and health system executives, nearly 81% reported that rising denial rates are a major stressor. The frustration is real, and so is the revenue walking out the door. What makes the problem more difficult is that most providers don't have a clear view of what denials […]

The Pre-Bill Blind Spot: A Post-Bill DRG Strategy for Revenue Cycle Leaders

The Pre-Bill Blind Spot: Why Your Paid Claims May Be Hiding More Revenue Than You Think

Your DRG program is working. Your CDI team is improving documentation. Your denial rates look manageable. So why are revenue cycle leaders at health systems across the country still leaving millions on the table every year?The answer is hiding in a window most RCM programs were never built to cover: the post-bill window, where two […]

Medicaid work requirements are live

What hospital revenue cycle leaders must do before August 2026Nebraska moved eight months ahead of the federal deadline. By January 2027, every expansion state must follow. On May 1, 2026, Nebraska became the first state in the nation to enforce Medicaid work requirements, launching eight months ahead of the federal deadline under H.R. 1 – the […]

AI as an operating model: Opening up EnableComp's playbook

An overview of EnableComp’s AI Transformation SeriesBy Brian Kenah, Chief Technology Officer, EnableCompEveryone in healthcare revenue cycle is talking about AI, but few offer specifics about what their AI actually does, how it was built, or how it is improving revenue. Those are the questions that matter.The wrong AI strategy carries a steep penalty today. […]