AdventHealth Pioneers AI-Powered Denials Prevention Strategy

Transforming Denials Management from Reactive to Proactive

While many health systems struggle with claim denial rates as high as 20%, AdventHealth is taking an innovative approach—using artificial intelligence to prevent denials before they occur. The Florida-based health system has implemented AI-driven tools that analyze medical documentation for potential issues prior to claim submission, creating a more efficient revenue cycle and better patient experience.

“By identifying documentation gaps early, we’re able to address them before they become claim denials,” said Dr. Christopher Riccard, Vice President of Hospital Medicine and Clinical Documentation Integrity at AdventHealth. “This proactive approach helps us reduce delays and confusion for patients while protecting our revenue stream.”

The High Cost of Claim Denials

Claim denials represent more than just an administrative headache:

$262 billion in provider revenue is tied up annually due to denials
Delayed reimbursements create financial strain for health systems
Patients face confusion and frustration when bills are disputed

“Denials don’t just hurt hospitals—they impact patients directly,” Riccard emphasized. “Our goal is to ensure accurate, timely billing so patients understand their financial responsibility without unnecessary delays.”

How AI Prevents Denials Before They Happen

AdventHealth’s partnership with Iodine Software has yielded a cutting-edge solution:

Post-Discharge, Pre-Bill Analysis: AI reviews medical records after patient discharge but before claim submission
Risk Flagging: Identifies unsupported diagnoses, missing documentation, and other potential denial triggers
Prioritized Workflow: Focuses on high-value cases with the greatest financial impact
Rapid Provider Engagement: 90% of documentation queries resolved within 24 hours

Key results include:

Faster, more accurate billing for patients
Increased revenue capture through targeted documentation improvement
Reduced administrative burden on clinical staff

Building an Intelligent Revenue Cycle Ecosystem

AdventHealth views AI-powered denials prevention as just the beginning. The health system is exploring broader applications of AI across the revenue cycle:

Emerging Technologies in Action

Ambient AI: Capturing clinician-patient conversations for automated documentation
Generative AI: Drafting denial appeals and prior authorization requests
Predictive Analytics: Identifying at-risk claims earlier in the process

Human-Centered Implementation

Riccard stresses that technology alone isn’t the solution: “Success requires thoughtful integration into existing workflows. We worked closely with our clinical teams to ensure these tools actually solve real problems rather than create new ones.”

The Future of Revenue Cycle Management

AdventHealth’s strategy represents a paradigm shift in healthcare finance:

From retrospective denials management to proactive prevention
From volume-based appeals to targeted, high-impact interventions
From administrative burden to streamlined, intelligent workflows

As Riccard notes: “Our ultimate goal is creating a self-correcting revenue cycle that supports both financial health and patient experience—where potential issues are identified and resolved almost before they emerge.”

The health system’s approach demonstrates how AI, when implemented strategically, can transform one of healthcare’s most persistent challenges into an opportunity for improvement across clinical, financial, and patient experience domains.