Revenue Cycle Management

Kimberly Hardin, Josh Rainey As healthcare organizations look to modernize operations, the idea of a fully artificial intelligence (AI)-driven revenue cycle management (RCM) system is increasingly appealing in urgent care. Automating everything from coding and charge capture to claims submission and denial management promises efficiency, speed, and reduced labor costs. However, moving to a truly autonomous AI model introduces a range of risks that organizations must carefully evaluate before making the leap. Financial Exposure and Revenue Integrity One of the most immediate concerns with full AI RCM in urgent care …
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Samantha Etter, CPC; Reanna Nelson, CPC Healthcare reimbursement processes continue to evolve. In 2026, diagnosis-based denials have increased significantly across multiple payer types. Unlike procedural denials, diagnosis denials often stem from policy interpretation rather than incorrect coding. For urgent care, each denial impacts revenue cycle performance, increases administrative burden, delays reimbursement, and raises compliance concerns. Understanding the root causes behind diagnosis denials is essential for proactive prevention and long-term revenue integrity. Historically, diagnosis denials were primarily linked to medical necessity or unspecified codes. Recent payer shifts now focus on symptom-based …
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Tricia Krueger, CPC; Nikki Benedict Insurers are drawing provider backlash for new payment policies that reduce reimbursements. For example, Cigna is automatically “downcoding” 6 evaluation and management (E/M) billing codes for a small percentage of providers, resulting in lower payments for routine services like office visits. Aetna’s new Medicare Advantage policy will automatically approve certain hospital admissions but reimburse them at the lower observation rate instead of the full inpatient rate. Providers argue these opaque methods increase administrative costs and lead to underpayment. Implications for Urgent Care Centers The new …
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Three types of artificial intelligence (AI) technologies are quickly moving to the urgent care exam room: real-time transcription; real-time coding; and clinical decision support systems.[1] They promise to reduce clinician burden per visit, improve documentation in the medical record, reduce cost per episode of care, and improve reimbursement. They may create challenges related to clinical ownership, medical decision making, and compliance, however.[2] Notes and code suggestions generated by AI for urgent care patients are likely to increase, but the clinician’s documentation will remain closely tied to their clinical reasoning and …
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Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC In the last few years, the Centers for Medicare & Medicaid Services (CMS) has accelerated its long-term effort to strengthen primary care as the foundation of the U.S. health system. Through new payment models, regulatory changes, and equity-driven initiatives, CMS aims to rebalance healthcare spending toward prevention, care coordination, and whole-person health. All these are areas historically underfunded compared to specialty or hospital care. Major policy changes have been enacted through the Physician Fee Schedule (PFS), including increased payment for longitudinal and continuous …
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