Healthcare De Jure: Paul Havey, Chief Client Officer, Revecore

In this episode of Healthcare NOW Radio, host Matt Fisher welcomes Paul Havey, Chief Client Officer at RevitCore, to discuss the complexities of healthcare revenue cycle management, with a focus on claims denials and the evolving role of technology. Havey explains that the revenue cycle follows the patient journey, from clinical care to billing and payment, and highlights three major challenges: denials, underpayments, and complex claims—especially those involving medical necessity or prior authorization. He notes that while administrative denials have decreased due to improved processes, more subjective and high-value denials have risen, creating significant financial and operational strain. The increasing use of AI by payers to issue denials at scale has intensified the burden on providers, prompting a technological arms race. RevitCore leverages AI and deep subject matter expertise to help hospitals appeal denials and recover lost revenue, emphasizing that human expertise remains essential despite automation. Havey predicts a shift toward proactive, predictive models that anticipate risks before they become issues, though systemic change remains slow. The episode concludes with a key insight: denials are not universally preventable due to an ever-evolving landscape, and the focus should be on effective response and recovery rather than perfection.