Hospital CFOs and revenue cycle leaders consistently rank these as the highest-impact operational challenges in 2025:
- Rising commercial payer denial rates. Commercial payer denial rates increased significantly post-COVID and have not fully recovered. Payers are applying stricter medical necessity criteria, increasing documentation requests on previously auto-adjudicated claims, and expanding prior authorization requirements to new service categories.
- Prior authorization volume and delays. The AMA reported that 94% of physicians say prior authorizations delay care. For hospitals, the administrative burden of managing prior auth across hundreds of payers — and the revenue risk of procedures performed without confirmed authorization — represents one of the largest controllable cost centers in the revenue cycle.
- Staffing shortages in coding and billing. Experienced coders and billing specialists are in short supply. Turnover is high. Many health systems are managing with understaffed teams, leading to claim backlogs, increased error rates, and unworked AR aging.
- Underpayment from payer contract discrepancies. Health systems are owed significant revenue from payers who apply incorrect fee schedules, bundle unbundleable services, or apply incorrect DRG assignments. Most underpayments go undetected without systematic EOB auditing.
- Multi-system complexity. Mergers and acquisitions have left many health systems managing billing across multiple EHRs, practice management platforms, and legacy billing systems — creating data silos, duplicate patient records, and inconsistent coding practices across sites.
Squadyen helps health systems address each of these through targeted RCM support — particularly in charge capture, coding accuracy, denial management, and underpayment recovery.