As Margins Thin, Rev Cycle Targeted for Optimization, AI May be the Key

HealthsystemCIO.com November 25, 2025
Anthony Guerra

Failing to modernize the mid-revenue cycle with AI-enabled workflows could become an existential issue for hospitals as payers deploy their own automation to scrutinize every claim. In the healthsystemCIO webinar “Exploring IT Optimization Opportunities in the Mid-Revenue Cycle,” panelists from Providence, Nathan Littauer Hospital & Nursing Home and e4health described a function that sits between patient access and back-end billing yet increasingly determines whether care delivery models remain financially viable.

At Providence, the mid-revenue cycle (MRC) spans clinical documentation, charge capture and reconciliation, coding for both professional and facility services, HCC risk capture, case management and utilization management, order accuracy, denials prevention and the clinical-to-billing translation inside the EHR. Those workflows connect clinical activity to reimbursement and quality measures, and...

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