Lexology June 24, 2025
Healthcare providers and revenue cycle management vendors face an increasingly challenging environment that is ripe for legal disputes.
For providers, margins are being compressed as labor, supplies and capital costs continue to rise faster than reimbursement rates. Meanwhile, payors are faced with their own economic pressures and have increased their scrutiny of every claim. This scrutiny translates into increasing procedural requirements, expanding the use of artificial intelligence in claims adjudication, and more frequent downcoding of procedures.
Providers often address these challenges by hiring revenue cycle management vendors. These vendors are expected to leverage their specialization, economies of scale, proprietary tools and global labor pool to help providers to receive timely reimbursement for their services.
At a macro level, revenue cycle...
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