Most conversations about revenue cycle performance focus on collections and cash uplift. Those numbers matter, but they only tell you half the story. The other half is what it costs you to assign your in-house revenue cycle team to cases they are ill-equipped to handle – the ones where regulations are constantly changing, rules can vary state to state, and the complexity is far beyond the skills most RCM staff possess.   

When your most capable staff spend their days on the most complex claims, you pay for it in slower cash flow, lower reimbursements, and staff burnout that puts you at risk of losing your best people. The American Hospital Association found that the average hospital assigns 59 full-time employees to regulatory compliance alone, and about a quarter of them are clinicians who would otherwise be caring for patients.  Pulling that much FTE effort into time-intensive, complex claims management instead of patient care just doesn't make sense." 

--> Where your people spend their time matters as much as what they collect. 

 

Standard workflows clear most of your claims –  a small share quietly consumes your team's valuable time 

Most health systems are built to process routine claims through standard EHR workflows. A smaller share, the complex claims and denials, falls outside that model. These claims often involve third-party liability, coordination of benefits across payers, or payer-specific documentation rules that standard EHR workflows were never built to handle. 

You can see it in how these claims get processed. According to the 2024 CAQH Index, claim submission is now 98 percent electronic, but prior authorization is only 35 percent electronic, and the documentation attachments complex claims require barely reach 32 percent.  

--> The hardest claims are exactly the ones that still have to be worked manually. 

In my experience, the small share accounts for around one-third of a revenue cycle team's time and resources. These claims increase denial rates, delay reimbursement, and divert trained staff from the high-volume commercial work where they add the most value. 

 

The hardest claims take the longest to pay, which stalls cash flow  

A standard medical claim often settles in about thirty days. A complex claim, like VA disability, takes around 70 days, and some even take months or years to close. That's your most experienced people tied up for weeks on a single claim, and reimbursement timelines extend far beyond those for non-complex claims. 

Your valuable people's time drains away, and cash flow slows to a trickle. The FTE drain doesn’t stop at claims. Complex clinical denials, including DRG downgrades, ED downgrades, medical necessity disputes and coordination-of-benefits issues, carry the same burden, along with the after-the-fact recovery work like zero-balance reviews and post-bill DRG validation.  

Fighting these denials is expensive. Premier estimates the cost of contesting a single denied claim at $57.23 in 2023, up from $43.84 the year before. Labor drives roughly 90 percent of that expense. 

Overloaded specialists burn out, and then they leave 

Skilled revenue cycle staff are hard to find and harder to keep, and the people who can work a complex claim are among the scarcest of all. When you put your team on the most frustrating work day after day, you raise the odds they burn out and leave. 

Administrative load drives a big portion of that burnout. A 36-hospital time and motion study found that documentation was the single largest use of nurses' time, at 35.3% of their shift, ahead of both care coordination and medication tasks. It’s the same in the revenue cycle, where the hardest claims carry the heaviest manual load. 

As a result, retention suffers. In a 2025 Black Book survey of more than 9,000 nurses, 69 percent named documentation burden and poor system usability as major reasons they wanted to leave. Hospitals with high turnover were 3.5 times more likely to be running difficult or outdated systems.  

--> Every hour lost to work better suited to a complexity expert makes it harder to keep the people you can't easily replace. 

 

5 Signs the FTE drain is already hitting you 

1. Your best people are on your most difficult-to-resolve claims. Your most experienced staff spend more time on complex claims than on the high-volume commercial work where they recover more, faster.  
2. Complex claims sit for months. They routinely stall past 60 to 90 days before they move, tying up the specialists assigned to them the whole time.  
3. Appeals stop after the first round. Your team gives up once the first attempt fails, and recoverable revenue gets written off by default.  
4. No one owns the complex work. Complex claims aren't a defined function, so the work gets absorbed across the team as it comes in, with no clear accountability or processing strategy.  
5. Turnover clusters on the hardest claims. The people working on your most difficult claims are the ones most likely to burn out and leave.  

If three or more sound familiar, the drain is already costing you, in cash and in capacity. Working harder on the same claims won't fix it. Start by measuring how much of your team's time complex work actually consumes, then decide which of it belongs in-house and which belongs with a complexity expert. 

 

The real lever is who works your complex claims 

You can't avoid these high-difficulty claims; they come with caring for patients, and the volume isn't going down. What you can decide is how the work gets done and who does it. 

That turns staffing for this claims segment into a strategic decision, one that directly affects your financial performance. Instead of spreading your team evenly across every claim type, put your people on the work where they recover the most, and bring in experts for the hardest cases. 

Example of how a complexity expert gets to root cause, not just the claim  

Consider a common case. A VA claim gets denied because an authorization never made it into the record. Your in-house associate can appeal and win the payment back, and most operations stop there. A complexity expert goes deeper, tracing that missing authorization back to registration, so the next VA claims don't fail the same way. 

--> By the time a claim is denied or underpaid, the money has already walked out the door, and preventing that loss costs far less than chasing it. 

 

Turning complexity into control 

Collections tell you what came in. They don't tell you what it cost to get there, or what your best people could have been doing instead.    

This is the problem EnableComp was built to solve. Its approach, Complex Revenue Intelligence™, is designed to uncover hidden revenue, adapt to payer and policy changes, and help revenue cycle leaders act before revenue is lost. It runs on the  e360 RCM platform®, an AI-driven rules engine trained on one of the industry's largest complex revenue cycle datasets, more than 60 million processed claims, and it submits claims electronically about 10 times faster than the industry average. 

It brings more than 25 years of specialized expertise to the same three areas that drain your FTEs: complex claims like VA and workers' compensation, complex denials like DRG and ED downgrades, and revenue recovery like zero-balance review and DRG validation.  

Recovering even a fraction of that FTE drain means more revenue captured and less burnout among the people you can least afford to lose. 

The complex revenue cycle doesn't have to be a constant drain. Learn how EnableComp helps hospitals manage complex claims, denials, and revenue recovery. 

 

About the author

Zachary Schultz, CSMC, CRCR, is a nationally recognized expert in Veterans Affairs, Out-of-State Medicaid,  and Workers’ Compensation policy and claim reimbursement. As the VP of Solutions Engineering at EnableComp, he maintains relationships with state regulatory agencies, large PPO networks, and payers. He also monitors and analyzes legal developments and legislative changes that impact EnableComp’s business and healthcare partners. Before joining EnableComp, he spent 10 years in operational management roles and served in the US Army, with deployments to Afghanistan for Operation Enduring Freedom.