Only Half of Health Leaders See AI Improving Reimbursement ROI; Payer Integration Remains a Pain Point

Survey: Only Half of Healthcare Leaders See AI and Advanced Analytics Driving Cost Efficiency and Reimbursement ROI

Healthcare finance and technology leaders are rethinking spend to protect revenue, improve efficiency, and stay compliant as reimbursement rules and interoperability standards keep shifting. A new survey from Becker's Healthcare and Net Health signals a push toward financial efficiency, regulatory readiness, and smarter, connected systems.

Across health systems, "reimbursement resilience" is now a core objective: sustaining predictable revenue despite policy uncertainty and operational complexity. Leaders are prioritizing tools that strengthen payer integration, reduce denials, and modernize EHRs while weighing where AI truly pays off.

Who was surveyed

The survey captured the views of 100 executives across health systems and hospitals, including CFOs, finance VPs, and clinical technology leaders. Respondents shared current pain points, investment priorities, and where they expect technology to deliver measurable ROI.

Key findings

• Regulatory uncertainty reshapes financial strategy: 42% are somewhat optimistic about potential reimbursement policy changes under the new administration, but concern remains high around data privacy laws (28%), value-based care implementation (27%), and interoperability mandates (26%). Top investment areas for the next year: revenue cycle management (RCM), compliance tools, and EHR upgrades.
• AI optimism with caution: Only 49% see AI and advanced analytics as a path to cost efficiency and reimbursement ROI; nearly as many are unsure. Adoption hinges on clear ROI, ease of use, and regulatory safety.
• Payer integration remains a sticking point: Interoperability changes rank among the top challenges this year. While 48% report full payer integration, 52% say their systems are only somewhat integrated with Medicare, Medicaid, and commercial payers for direct EHR billing and reimbursement workflows.
• Modernization with measurable outcomes: Leaders are focused on reducing denials, protecting compliance integrity, and updating EHRs to support evolving care models and payer demands.

Why this matters

Volatile rules and fragmented payer connectivity drain revenue and operational time. Tech investments are shifting from "nice to have" to "prove it." Finance and IT leaders want systems that reduce denial rates, shorten A/R, and simplify audits-without adding documentation burden or compliance risk.

Where AI fits today

• High-ROI use cases: denial prediction and worklist prioritization, prior authorization support, coding and documentation assistance inside the EHR, and audit-ready compliance checks.
• Adoption criteria: validated ROI in similar settings, simple clinician and RCM workflows, explainable outputs, PHI safeguards, audit trails, and clear vendor accountability.
• Guardrails: align with payer policies, keep models and prompts traceable, and ensure data minimization by default.

Payer integration: from partial to practical

• Close the gap on eligibility, benefits, and prior auth data flows with payer APIs and clearinghouse integrations.
• Push remits and denials back into the EHR with standardized mapping to speed root-cause fixes.
• Use analytics to flag trends by payer, service line, and location; route complex claims to specialists early.

Compliance and interoperability: focus areas

• Stay current on interoperability and information sharing requirements to avoid penalties and workflow friction. See: CMS Interoperability & Prior Authorization and ONC Information Blocking.
• Invest in audit-ready logging, consent management, and data minimization across RCM and clinical systems.
• Build joint governance between compliance, privacy, IT, and revenue cycle to vet new tools and monitor outcomes.

12-month action plan for health systems

• Prioritize RCM modernization tied to measurable targets: denial reduction, days in A/R, cost-to-collect.
• Upgrade EHR modules that improve prior auth, eligibility, and remittance processing; expand payer connectivity.
• Pilot AI in one or two high-yield areas with clear baselines and quarterly ROI reviews.
• Strengthen compliance tooling: data loss prevention, PHI access monitoring, and documentation audit trails.
• Upskill finance and operations teams on AI, analytics literacy, and vendor risk management.

About Net Health

Net Health provides specialized software that helps more than 25,000 healthcare organizations improve patient outcomes and financial performance across wound care and rehab therapy. Their platforms span EHRs, patient engagement, and predictive analytics, supporting administrators, clinicians, and executives.

Learn more at nethealth.com.

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