By most accounts, the first wave of AI adoption in healthcare revenue cycle management (RCM) has been swift.
AI spending overall in healthcare nearly tripled between 2024 and 2025 to $1.4 billion.1 RCM functionality—including coding and billing automation, patient engagement, and prior authorization support—were among the top areas of investment.1 By 2026, 75% of US health systems reported using at least one AI application, up from 59% in 2025.2 The most widely adopted AI solutions include RCM functionalities such as coding, denial prediction, admin chatbots, and pre-populated appeals.2
This pace of adoption is particularly notable on the side of the industry often associated with slow tech. Case in point, the Centers for Medicare & Medicaid Services (CMS) didn’t officially call for the phase-out of fax machines in claims processing until 2026.3
In this first wave of AI and automation, advancements in healthcare RCM have been incremental, focused on exploring the technology by automating isolated manual tasks. The question now is what comes next from AI and automation in healthcare RCM, and how far can we go with the friction between payer and provider.
From my vantage point leading large-scale, tech-enabled transformations across health systems for nearly two decades, the next step is both clear and critical: Organizations must pivot from incremental tech deployment to strategic operational transformation. Now that we know what the technology can do, what do we want it to do? How do we ensure it actually works to accomplish our business goals?
Many provider organizations initially examined AI and automation technology largely from a technology leadership perspective. Next-level tech-enabled RCM requires you to zoom out, viewing the technology through a broader operations lens and using it strategically to improve revenue. There is a tendency with AI for organizations to implement a single tool here or there and declare victory. True success, however, requires a big-picture approach and a firm grasp of your organization’s foundational goals. As you align objectives and evaluate opportunities, these are the fundamental issues to consider.
End-to-End Actionability
Healthcare’s early forays into AI and automation technology leveraged generative AI, automating one task at a time to improve individual manual processes.4 Next-level leaders are now focused on agentic AI, which can take action to manage processes from end to end.4
In healthcare RCM we see many tools deployed for pieces and parts of workflows. The challenge is to stitch them together with actionable solutions that can handle the entire workflow.
Where we once automated the isolated task of pulling claim status from the payer’s system into ours, now we target the complete appeals workflow. Using agentic AI, our workflow solutions bridge the steps and take the next evidence-based action all the way through to resolution. They use data to predict the appeal method most likely to be successful; automatically generate compliant communications; attach required documentation; and autonomously submit the appeal through the payer’s preferred channel. We’ve built human oversight into the workflow, but it no longer has to gate every step.
Actionability is extremely efficient, certainly, but it’s also scalable. It allows organizations to manage unexpected volume spikes, continuously scan for payer and regulatory changes that will impact claims processing, and divert human resources to high-value strategic initiatives.
Core-Business Alignment
Effective workflows are more than the sum of their tasks, however. Every workflow ultimately needs to serve the organization’s fundamental business goals. In healthcare RCM, the end goal is cash, and that’s the ultimate metric we use to evaluate our AI and automation workflows.
From a data and analytics perspective, Ventra monitors hundreds of individual controls, which roll up to five core service metrics that we consider our RCM Metrics that Matter for facility-based physician groups:5
- Net Collections Rate (NCR)
- Net Cash Collections (NCC)
- Cash Per Unit (CPU)
- Days in Accounts Receivable (AR)
- Percentage of Accounts Receivable (AR) > 120 Days
Collectively, they are all about cash: retaining revenue and accelerating payment. Ventra’s AI and automation solutions map directly to core metrics, measuring how well we collect every dollar clients have earned, how quickly claims are processed and paid, and how effectively we liquidate accounts receivable into cash.
Much of the impact we can have on retaining revenue and accelerating payment is upstream. If we can use AI and automation on the front end to capture every billable service, submit cleaner claims, and reduce the potential for denials, we achieve improved revenue and reimbursement as cumulative effects.
Digital Patient Engagement
While providers are embracing AI and automation internally, some are still reluctant to adopt patient-facing digital solutions, fearing that technology such as chat-assisted contact center options and digital statements will turn patients off.
The data suggests the opposite is true. Most patients now prefer to pay their bills online,6 and they’ll pay faster when they receive their statements through their preferred digital channels.7 Consumer comfort with chat technology also continues to increase. Across all industries, 82% of customers prefer chatbots over waiting for a representative—an increase of 20% between 2022 and 2025.8
A Ventra client recently asked us to turn off digital statements for their patients. Practice leaders changed their minds when we presented data showing that patient payments went up 40% when digital statements were active.
Digital patient-facing solutions are integral to the next-level AI and automation workflows that will help providers improve cash flow. In addition to faster payment, they facilitate accurate data entry for cleaner claims and fewer denials. They also help us serve patients better with features like 24-hour contact center engagement and expanded language options.
Patients already expect digital interactions in banking, shopping, and even on the clinical side of healthcare. Leveraging them now on the payment side will strengthen your revenue cycle and your patient engagement.
How Ventra Can Help
vCisionTM, Ventra’s revenue intelligence platform, leverages the most advanced agentic AI technology and data models to target impactful opportunities for improvement in the revenue cycle. Grounded in Ventra’s own data and insights, it enables our RCM experts to improve claim processing accuracy, reduce preventable denials, anticipate and adapt to payer behavior, and maximize reimbursement.
Ventra’s service delivery team and technology team partnered from the start of discovery to ensure that every solution we designed was actionable and centered around the core goals of retaining revenue and accelerating payment. In just the first few months after the official launch of vCision, our teams saw a 19% improvement in first-pass payment rates and 26% fewer initial denials.
As reimbursement rates decline and payers continue to put new obstacles in the way of payment,9 Ventra believes that intelligent technology and the proactive use of data will mean the difference between success and failure for facility-based practices. We empower our teams with actionable, expert-guided solutions to solve real-world revenue problems by:
- Improving claim accuracy for first-pass processing
- Preventing denials before the claim is released
- Anticipating and adapting to changing payer rules
- Identifying potential revenue leakage through issues like underpayments
The next phase of AI forces a version of the age-old “better, faster, cheaper ” tradeoff with tension between the speed of implementation, workflow integrity, and sustainable outcomes.
Organizations that rush AI deployment often see short-term efficiency gains followed by downstream issues. The hidden cost to moving fast manifests in disjointed workflows, piecemeal solutions, and inefficient hand-offs that are a result of point-solutions instead of holistic workflows.
Most organizations sacrifice at least one variable to accomplish the other two, but Ventra has intentionally created a balance by remaining laser-focused on actionable solutions that tie directly to core-business goals. Technology at Ventra is not the “shiny new object” but rather a tool that measurably helps clients accelerate and retain more of the cash they’ve earned.
About Erica Franko
As Executive Vice President and Chief Operating Officer, Erica leads enterprise-wide process and technology improvements to optimize how Ventra Health serves its physician partners. For nearly two decades, Erica has focused on transforming operational performance, revenue cycle management, and patient experience with technology-enabled solutions that meet the needs of both patients and healthcare providers. Her extensive experience includes senior leadership positions at AGS Health and nThrive (now FinThrive). As a consultant at Accenture, she advised Top 20 healthcare organizations on growth strategy and large-scale transformations.
Resources
1 “AI Adoption In Healthcare Is Surging: What A New Report Reveals,” Forbes, Oct. 21, 2025, accessed May 28, 2026, at https://www.forbes.com/sites/sachinjain/2025/10/21/ai-adoption-in-healthcare-is-surging-what-a-new-report-reveals/
2 “Health system AI adoption surges in 2026 with execs reporting increased ROI: survey,” Fierce Healthcare, Mar. 24, 2026, accessed May 28, 2026, at https://www.fiercehealthcare.com/ai-and-machine-learning/75-us-healthcare-systems-use-plan-use-ai-platform-2026
3 “’The 1980s Called’: CMS Rule Aims to Phase Out Fax Machines for Health Claims,” Medpage Today, Mar. 23, 2026, accessed May 28, 2026, at https://www.medpagetoday.com/practicemanagement/reimbursement/120451
4 “Generative AI in healthcare: Adoption matures as agentic AI emerges,” McKinsey & Company, Apr. 16, 2026, accessed May 28, 2026, at https://www.mckinsey.com/industries/healthcare/our-insights/generative-ai-in-healthcare-current-trends-and-future-outlook
5 Becker’s Webinar: 5 RCM Metrics that Matter for Facility-Based Physician Groups,” Ventra Health, May 21, 2025, accessed May 28, 2026, at https://ventrahealth.com/webinars/5-rcm-metrics-that-matter/
6 “Trends in Healthcare Payments report reveals patient collections are primary revenue concern for providers,” J.P. Morgan, May 21, 2025, accessed May 28, 2026, at https://www.jpmorgan.com/payments/newsroom/healthcare-payments-trends-report-2025
7 “32% of People Will Pay Their Medical Bill Within 5 Minutes of Getting a Text About It,” HealthLeaders, Oct. 15, 2021, accessed May 28, 2026, at https://www.healthleadersmedia.com/revenue-cycle/32-people-will-pay-their-medical-bill-within-5-minutes-getting-text-about-it
8 “58 Key Chatbot Statistics for 2025 That Explore Its Growth,” G2, Dec. 12, 2024, accessed May 28, 2026, at https://learn.g2.com/chatbot-statistics
9 “4 Bad Payer Behaviors that are Impacting Reimbursement for Facility-Based Physician Groups,” Becker’s Hospital Review, Jan. 31, 2025, accessed May 28, 2026, at https://www.beckershospitalreview.com/hospital-management-administration/4-bad-payer-behaviors-that-are-impacting-reimbursement-for-facility-based-physician-groups/
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