I typically start my mornings with a little silence before the hustle and bustle of the day begins. One morning, the silence was interrupted by a frantic call from my father saying something was not right with my mom. For the next 60 seconds, there was a rapid fire of questions that ultimately ended with “Dad, hang up. Call 9-1-1. When they arrive, tell them that due to mom’s history, we would like her to be airlifted to Vanderbilt. I will meet you there.” Unfortunately, we lost my mother several days later.
A month later, my father opened a bill for $45,000. His expression shifted instantly—concern, then panic. I reviewed the invoice and, because of my background in revenue cycle, quickly identified the issue and had the balance corrected to $0.
I am thankful for the care my mother received. However, I am a firm believer that patient advocacy is not the sole burden of clinicians. It is our responsibility as a healthcare community to champion transparency and advocacy before and after a patient receives medical treatment.
My introduction to healthcare came at the dawn of a transition from paper charting to electronic health records. Paper charting allowed for more time for human connection, perhaps even clinical autonomy. However, it lacked consistency and data visibility. Care felt personal, but systems were limited. Within a few years, a robust set of incentives were introduced under initiatives such as Meaningful Use. The EHR solved problems of efficiency, standardization and data accessibility. It potentially offered solutions that could lead to a reduction in coding errors and an increase in clean claims—and faster timeliness of claim adjudication along with it.
What wasn’t fully accounted for were the unintended consequences: increased administrative burden, strained workflows and growing tension between payers and providers. Was this the beginning of the loss of patient advocacy?
When I transitioned into facility revenue cycle, I saw first-hand the complexity patients and front-end hospital staff face, sometimes choosing from hundreds of insurers, each with their own criteria to meet medical necessity. This variability often offsets the efficiencies we hoped standardization would bring. The administrative burden at the time a patient is seen, and after a claim has been billed, creates even more distance between the patient and their own care. Decisions are made regarding documentation, not lived experience. The patient’s voice is siloed from payer interpretation. The patient transitions from being an active participant in their care to interacting with the outcome of a system they cannot see.
If the system during this time is complicated, fragmented and somewhat disconnected for the patient, where does patient advocacy fit into a world filled with generative AI and automated solutions?
Paradoxically, the same technological acceleration that widened this distance may now offer a path back. Generative AI and automation, when implemented responsibly and supported by strong governance and human oversight, can restore the relationship between provider and payer—and return the patient’s voice to the center of the conversation.
With the correct automations in place, we can move from a siloed patient care system into a complete end-to-end narrative allowing us to not only treat the patient holistically, but to offer a continuum of patient care and advocacy well after patients are discharged. Algorithms that objectively assess medical necessity can ease tensions between providers and payers. Routine tasks can be accelerated, allowing administrators more time to give individual patients attention. Patients and their loved ones can spend less time navigating a system and more time focused on getting well.
These tools also provide the perfect environment to reintroduce a culture that views a claim number or account number as more than a numerical identifier. We can ensure that an unexpected balance doesn’t become a source of confusion or fear for a patient’s family. We can choose each day to show up in spaces where the patient is not directly invited into the room.
Revenue cycle leaders sometimes describe their work in terms of “low-hanging fruit”—accounts that are easy to resolve, denials that are straightforward to overturn. But reframing that instinct is part of the mission. Getting a patient approved for the skilled nursing facility they need, or the medication their care plan requires, isn't just a revenue protection strategy. It's an act of patient advocacy. It restores dignity. Working with payers to ensure every patient is covered at the appropriate level of care isn't a back-office function—it's the place where revenue cycle managers can show up for patients who aren't in the room.
I'm grateful I was with my father when he opened that bill. But as a healthcare community, we must ensure patients don't need someone like me in the room to experience clarity, advocacy and dignity. We must build systems that provide it automatically.
Cassandra Skinner is a value realization partner at Xsolis, and has more than a decade of revenue cycle and payer experience from Parallon, HCA Healthcare's revenue cycle subsidiary.