Paul Havey, Chief Customer Officer at Revecore, recently joined host Matt Fisher on Healthcare De Jure, part of the HealthcareNOW Radio network, to talk through the lifecycle of a hospital claim, the evolving denial landscape, and where he sees the industry heading. It’s a wide-ranging conversation with a lot of practical ground covered.
In a conversation that spans the full arc of what happens to a claim after care is delivered, Matt and Paul dig into why denials have grown in both volume and complexity over the last decade, how payers and providers are each deploying technology to gain the upper hand, and what a more proactive approach to revenue cycle might actually look like in practice.
Listen to the full episode of Healthcare De Jure featuring Paul Havey on the HealthcareNOW Radio network.
A few key takeaways:
The denial landscape has shifted — and keeps shifting.
Earlier waves of denials were largely administrative: coding errors, eligibility gaps, missed authorizations. Providers got better at those over time. What’s grown in their place is more complex — medical necessity disputes, clinical judgment calls, and what Paul describes as an “error basket” of denials that don’t have a clear rationale under the agreed-upon rules between payers and providers. A Health Affairs analysis found that Medicare Advantage plans denied about 17% of initial claims submissions, and 57% of those denials were ultimately overturned on appeal.
Low-dollar denials are a bigger problem than they look.
Individual low-value claims do not often seem worth the cost of appealing — if it costs more to fight a low-value denial than the reimbursement at stake, most providers absorb the loss. But those denials accumulate. The American Hospital Association estimates hospitals spent $43 billion in 2025 trying to collect payments insurers already owed, and an HFMA Pulse Survey found the average hospital loses 4.8% of net revenue to denials annually. The low-dollar piece of that is a meaningful and often undercounted contributor.
AI is accelerating the problem — and the response.
Payers have been using AI to issue denials faster and at greater scale. That’s created a volume problem for providers that traditional staffing models weren’t built to handle. The same technology is being applied on the provider side, but Paul is clear-eyed about its limits: clinical expertise still matters, especially for complex cases, and probably always will. What’s changing is how that expertise gets used — less on drafting appeals from scratch, more on reviewing and refining what the tools produce.
Denials aren’t fully preventable — and expecting them to be creates its own risk.
One of the most useful points in the episode is Paul’s pushback on the idea that a good enough prevention strategy eventually solves the denial problem. As he noted, the landscape keeps evolving, and new denial types keep emerging. Organizations that treat response capability as seriously as prevention tend to be better positioned when the next wave arrives.
Revecore works with more than 1,300 hospitals and health systems on complex revenue cycle challenges, including denials management, underpayment recovery, and complex claims recovery. Our approach combines purpose-built technology with deep clinical and operational expertise — because in a denial environment this complex, both matter.
Listen to the full episode of Healthcare De Jure featuring Paul Havey on the HealthcareNOW Radio network.