Sally Ragab, Founder & CEO @ Neunetix.
Ask any healthcare clinic owner where they lose money, and most will point to low reimbursement rates or high overhead. But in my experience, few will mention the real culprit: Denied claims.
Increases in costs in hospitals and healthcare systems are not keeping pace with reimbursement rates from Medicare and Medicaid. In 2023, U.S. healthcare providers spent an estimated $25.7 billion contesting insurance claim denials, with nearly $18 billion potentially wasted on claims that were ultimately paid after multiple rounds of reviews. These aren’t marginal costs—they’re symptoms of deep inefficiencies in how revenue cycle operations are run.
What’s worse? For small clinics, especially orthopedic and specialty providers, these denials create a hidden tax on growth. Staff burn out trying to resubmit claims. Revenue becomes unpredictable. And leadership is left guessing where the money is leaking.
This isn’t just a billing problem; it’s a business risk. One clinic I spoke to recently said they had over $180,000 in denials sitting untouched for the past 12 months. That’s not a rounding error. That’s a missed payroll.
What We’re Getting Wrong About Revenue Recovery
Many in the industry assume that the solution to claim denials is either hiring more billers or outsourcing to another billing company. But that just adds more hands to a broken process.
I’ve found that the real problem is systemic fragmentation. Most clinics operate across three to seven disconnected platforms—EHR, clearinghouse, billing software, remittance systems and more. Denied claims fall through the cracks, especially when staff are already overwhelmed and under-resourced.
And when traditional RCM vendors charge 6% to 10% of collections but still miss denials, clinics are left paying for inefficiency. These are sunk costs for most practices, with no clear performance accountability.
Clinics Don’t Need More Software, They Need Results
Building systems to fix this, I’ve learned that the most effective solutions have three traits:
1. Pay-For-Performance Alignment: When partners are only paid based on what they recover, it creates sharp focus and true accountability.
2. Cross-System Data Visibility: Denials often stem from disjointed workflows. Bringing billing, clinical and remittance data into one view is what prevents costly gaps.
3. AI Prioritization: Not all denials are worth pursuing. Machine learning can be used to sort winnable claims from low-value dead ends, reducing wasted effort and accelerating collections.
Instead of adding more dashboards or staff, clinics need to shift toward outcome-based strategies that reduce administrative burden and improve cash flow.
This shift requires providers to ask harder questions: Are we measuring what matters? Are our vendors truly incentivized to help us succeed? Are we using data to prevent denials—not just react to them?
Why This Matters Now More Than Ever
Under stricter healthcare policies, cost control will become the new gold standard for private clinics. Automation won’t be optional—it’ll be survival. AI-driven claim recovery will shift from “nice to have” to “need to have.”
AI isn’t here to replace billers. It’s here to amplify them. And for small providers that have historically been underserved by big healthcare tech, it’s a game-changer. It’s a shift from reactive firefighting to proactive, scalable revenue management.
My Advice To Healthcare Executives
1. Stop tolerating denial rates above 5%. That’s not normal; it’s fixable.
2. Don’t build more dashboards. Build results. Your staff need relief, not more screens.
3. Find partners who bet on your success. If they’re not willing to tie their fees to performance, they’re not truly aligned with your outcomes.
The clinics that thrive in the next decade won’t be the ones with the fanciest tech. They’ll be the ones who recover every dollar they’re owed—and do it with less human effort.
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