CorroHealth is a healthcare technology and revenue cycle management company that helps hospitals, health systems, and health plans manage reimbursement more effectively. Operating as a single, connected platform, its work combines clinical expertise, analytics, and AI-enabled technology to support documentation, coding, claims, and denials management.
Why has hospital reimbursement become so difficult to manage in the current U.S. healthcare environment?
Hospital reimbursement has always been complicated. The U.S. has created a highly complex system, and health systems are now facing additional pressure from regulatory change, the tension between traditional fee-for-service and value-based care, and the current focus on fraud, waste and abuse.
That leaves health systems trying to determine which side of the fence they are operating on: traditional fee-for-service, value-based care, or some combination of the two. Prior authorization reform may help streamline a process that has been clunky in the past, but overall, reimbursement is becoming more difficult to manage than it has historically been.
How is the transition from fee-for-service to value-based care changing the way hospitals need to think about reimbursement?
In a fee-for-service environment, success is defined in one way. In value-based care, it is very different: the focus is on managing the cost of care rather than the more episodic model associated with fee-for-service. Those models can be somewhat contradictory, and hospitals need to understand how to operate across both.
That shift makes clinical documentation even more important. As organizations move into value-based care, they need to understand the patient’s conditions and what has to be done proactively to manage them. Given the limited amount of time clinicians have with patients, documentation does not always rise to the top of the chart in terms of priorities, even though it is becoming increasingly central to both reimbursement and care.
How does CorroHealth support clinicians and health systems in capturing the full clinical picture behind a claim?
CorroHealth supports clinicians through technology and solutions focused on clinical documentation and a fuller view of the patient’s story. Its inpatient platform, VISION Clinical Validation Technology®, and its outpatient platform, CARAT®, are designed to help ensure that relevant documentation is captured across care settings.
The combination of those solutions is important because the true clinical picture provides insights related not only to reimbursement, but also to care. CorroHealth also surrounds the technology with services where automation may not completely solve the problem, helping health systems drive efficiency, support documentation workflows, strengthen the claims process, and better negotiate contracts.
What does CorroHealth’s position between clinical care and hospital finance reveal about the pressure points in the system?
The pressure point is the clinician’s time: the time available to spend with the patient, and the time available to document that care accurately. Much of the evolution around ambient listening and ambient documentation is intended to support clinicians so they can spend the right amount of time with patients while still ensuring that the necessary record is complete.
CorroHealth’s role is to validate that documentation, ensure nothing is missing, and confirm that it supports the care provided. The aim is to show that the care was appropriate, and that reimbursement accurately reflects it, in a compliant manner. That connection between the clinical and financial sides of the system is where much of the complexity now sits.
Why are claims denials increasing, and which areas of reimbursement are most exposed?
The easy answer is to blame the payers, but the root causes are more complicated. Payers continue to change the rules around reimbursement, and that is one of the ways reimbursement is managed today. There are also denials associated with documentation, particularly around the medical necessity of care.
Other denials are tied to registration, demographics and resource constraints within the health system. It is the combination of these issues that makes denials so difficult to address; there is not one single driver. The most vulnerable claims are generally higher-complexity, higher-value claims, while Medicare Advantage and managed care-related denials are also increasing because they carry different reimbursement and documentation requirements. There is also more analytic oversight of utilization patterns, including some lower-complexity, higher-volume procedures.
Where is automation genuinely improving revenue cycle work, and what should health systems be wary of as they adopt AI?
AI is making ground, but it remains early stage. It is not at a point, and probably will never be at a point, where it solves the problem 100%. The real question is how to combine automation with domain expertise so that it drives the right solution in the right setting.
In inpatient care, where a medical chart can run from 100 to several thousand pages, automation is very effective at pointing a clinician to the area of the chart that may need additional review. In outpatient visits, automation can be more effective at providing a no-touch solution. Health systems should be realistic, test carefully and understand that automation is not a complete answer. It works best when organizations adapt their processes to the automation, rather than trying to force automation over existing processes. Standardization and change management are therefore critical.
What must change for the hospital back office to become smaller, more efficient and more automated?
The hospital back office has to become smaller and much more efficient. A major barrier is the lack of standardization in healthcare, which drives administrative cost. That lack of standardization is partly the result of payer rules and partly the result of processes providers have adopted over time.
Reducing friction will require some give and take between providers and payers. More consistent processes would allow automation to operate at a much higher level, because fragmented workflows are extremely difficult to automate. CorroHealth helps by offloading complex processes that need additional attention, as well as high-volume, lower-complexity work that is ripe for standardization. That, in turn, creates the foundation to apply automation at scale and move toward a more efficient operating model.
