Where revenue leakage drains healthcare—and how to fix the revenue cycle

A system under pressure

Increases in claim denials, rising write-offs, and staffing shortages continue to challenge the healthcare revenue cycle. For many health systems, the financial impact reaches into the millions each year. Every reworked claim adds cost. Every delay reduces margin. And unresolved denials limit a hospital’s ability to reinvest in patient care.

Maintaining the status quo is becoming increasingly unsustainable—but change also opens the door to stronger margins, more resilient operations, and renewed focus on patient care.

Why yesterday’s fixes are sinking today’s margins

Health systems have tried to solve revenue cycle problems by hiring more staff, outsourcing work, and investing in technology upgrades. These strategies delivered partial relief but failed to address root causes—and the costs keep climbing:

• More staff drive up costs without keeping pace with payer complexity. Prior authorization volumes have increased 30% since 2022, contributing to an estimated $1.3 billion in annual spend.

• Electronic health record (EHR) and billing systems digitized records but left gaps between providers and payers. Manual claims statusing still costs up to $9 per claim and takes nearly 19 minutes for each.

• Outsourcing shifts the work but not the bottlenecks. Denials remain a multimillion-dollar challenge, with up to 70% of initially denied claims later overturned on appeal—representing nearly $18 billion potentially wasted on disputes over claims that should have been paid at submission.

The reality: health systems are spending more each year, yet remain outpaced by changes that demand a more adaptable operating model.

The new model for revenue cycle management

Agentic automation unifies AI agents, robots, and people into one coordinated workforce. It orchestrates processes across existing EHRs, billing platforms, and payer portals—building on, not replacing, current systems.

• AI agents interpret context, adapt to changing payer requirements, and make goal-driven decisions in real time

• Robots execute rules-based, repetitive tasks quickly and accurately

• People remain central as the humans in the loop, stepping in for approvals or exceptions with full visibility

This isn’t automation for efficiency’s sake. It’s an operating model shift that turns a fragile, reactive revenue cycle into one that is adaptive and resilient.

Millions in recovered revenue

Referrals management

Manual referrals often stall or get lost, pushing patients out of network and draining revenue. With agentic automation, referrals are routed, classified, and entered the same day. At one national research hospital, the referral management process that previously took more than three days was reduced to same day—helping reduce leakage and retain millions in revenue. They also realized more than $500,000 in annual savings and cut downstream labor costs by about $100,000.

Prior authorization

Manual prior authorization processes are slow, error-prone, and inconsistent, consuming staff time and resulting in more denials. Together, AI agents and robots keep payer requirements current, automatically submit requests, and track approvals in real time. One regional provider used this approach to manage over 425,000 requests, achieve 100% prior authorization requests check coverage, and save $850,000 annually. And they did it all while accelerating approvals and strengthening cash flow.

Denials management

Denied claims pile up into multimillion-dollar backlogs, delaying payments and wasting staff effort. With agentic automation, documentation is retrieved immediately, claims are resubmitted, and responses tracked without delay. A university hospital system drove a $14 million increase in revenue by appealing denials in real time, while another provider eliminated a $15 million backlog of unprocessed claims. What was once a bottleneck is now a source of recovered revenue and stronger financial health.

For executives, these aren’t just operational wins. They are margin protection strategies in an environment where every dollar matters.

Why this belongs in the boardroom

The revenue cycle is no longer just an operational issue. It’s a boardroom priority that directly affects financial stability, workforce resilience, and patient satisfaction. With agentic automation, leaders and teams can expect meaningful improvements across the organization:

• For chief financial officers (CFOs) and chief operating officers (COOs): fewer write-offs, faster reimbursement, and stronger margins

• For chief information officers (CIOs): integration with existing systems without the disruption of rip-and-replace projects

• For staff and clinicians: less administrative burden means more time for higher-value work

• For patients: faster approvals and fewer billing surprises improve access and trust

The path forward

Margins won’t hold under the current model. Hospitals need revenue cycles that adapt in real time—powered by agentic automation—to protect revenue and strengthen patient trust.

The healthcare revenue cycle is under strain, and the status quo is becoming harder to sustain. Without new approaches, costs will continue to rise and margins will erode.

UiPath is the agentic automation platform for healthcare, built to help health systems get paid faster, with less manual effort, while freeing staff to focus on the work that matters most.

Learn more about transforming the revenue cycle.

Sources:

• American Medical Association, Prior authorization delays care—and increases health care costs

• Becker's Hospital Review, Manually chasing claims costs providers 19 minutes, $9.37 on average

• Premier Inc., Claims Adjudication Costs Providers $25.7 Billion - $18 Billion is Potentially Unnecessary Expense