Article
Inside a $15 billion revenue cycle
The system’s revenue cycle team collected more than $15 billion in U.S. net patient revenue in 2025, according to an interview published June 25. The operation has more than 3,800 full-time equivalents, about 40% of the work is outsourced, and the cost to collect is 2.92%. It runs roughly 200 software bots that handle repetitive tasks.
About 15% of incoming claims are denied, counting first and later denials. Last year the team overturned 92% of denials, holding net controllable losses below 2%. To get there, Cleveland Clinic placed two medical directors inside revenue cycle operations, one focused on documentation quality, and built a physician advisory program so clinical reasoning supports claims before they go out. New coding tools are being introduced with a human reviewer checking every result before submission.
Why winning appeals is not enough
Chief Financial Officer Dennis Laraway has argued that the work required to move from a 15% denial rate to less than 2% in losses is enormous and unsustainable for both hospitals and insurers. In a December interview he described it as unproductive friction and warned against an escalating contest between provider and payer software. His alternative is agreement on standards for claim and chart review, joint operating committees and shared audits. Under such terms, he projects, about 95% of claims could be paid automatically.
Tracy Peffley, who leads revenue cycle management, has made a similar case for moving from a reactive model toward near real-time claim adjudication built on provider and payer collaboration.
Questions for your technology roadmap
- What are we automating? Tools that speed appeals reduce labor but do not lower denial volume. Prioritize work that prevents denials at registration, authorization and documentation.
- Where is clinical input? Embedding physicians in revenue cycle decisions can stop secondary and tertiary denials before they start.
- Do we share data with payers? Explore pilots that exchange clinical documentation electronically and agree on review rules up front.
- How do we measure success? Track initial denial rate, cost to collect and days to final payment, not only overturn rates.
For most systems, the biggest return will come from fewer disputes, not faster ones.
Archive entry for Jun 29, 2026, added Nov. 11, 2026.