EnableComp, XTend Healthcare, Cedar, Knowtion Health, and others recognized as top performers in ten distinct AR categories, as health systems and providers acknowledge that complex AR recovery is not a one-size-fits-all challenge
DENVER, June 26, 2025 (Newswire.com) - Hospitals and health systems are facing unprecedented strain from unresolved, complex accounts receivable (AR), particularly in segments involving legal, regulatory, or high-dollar clinical factors. According to Black Book Research's 2025 survey of 902 U.S. provider revenue cycle executives, over 42% of aging AR is now tied to complex claims that require advanced capabilities far beyond standard billing office functions.
"Provider organizations can no longer afford to let complex claims stall in their aging buckets," said Doug Brown, Founder of Black Book Research. "Specialized AR segments demand precise recovery models, policy fluency, and advanced denial intelligence - whether the issue is payer resistance, clinical ambiguity, or legal complexity."
Ten High-Impact Complex AR Categories in 2025
Workers' Compensation & Third-Party Liability These claims demand extensive legal coordination, state-specific rules adherence, and long-cycle tracking due to employer and insurer documentation requirements. Top Rated Vendor: EnableComp
Veterans Affairs (VA) & TRICARE Providers continue to report operational frustration with federal healthcare programs, including delayed authorizations, inconsistent reimbursement standards, and time-intensive appeals. Top Rated Vendor: EnableComp
Motor Vehicle Accident (MVA) and Personal Injury These claims frequently intersect with ongoing litigation, unclear payer responsibility, and documentation demands that require payer and legal team coordination. Top Rated Vendor: EnableComp
Clinical Denials & Medical Necessity Appeals Claims denied for inpatient status, medical necessity, or DRG assignment have the highest financial exposure. These require clinically credentialed teams and deep payer-specific appeal tactics. Top Rated Vendor: Knowtion Health
Legacy AR and Runoff Accounts Aging AR tied to facility acquisitions, EHR transitions, or defunct cost centers often stagnate unless recovered by firms with reconciliation and platform-agnostic retrieval skills. Top Rated Vendor: XTend Healthcare
High-Balance Self-Pay and Underinsured The rise of high-deductible health plans has pushed significant payment responsibility onto patients. Recovery depends on empathetic, data-driven financial engagement tools. Top Rated Vendor: Cedar
Medicaid and Indigent Care Retroactive eligibility, manual processing, and fragmented state regulations continue to challenge providers attempting to collect from public and indigent payer programs. Top Rated Vendor: XTend Healthcare
International and Cross-Border Claims Payers outside the U.S., including embassies and foreign insurers, add complexity through documentation differences, language barriers, and verification delays. Top Rated Vendor: Nymbl Systems
Out-of-Network and No Authorization Claims These denied claims often require extensive appeal documentation and are prone to long legal or negotiation cycles before partial payments are issued. Top Rated Vendor: Intersect Healthcare
Social Determinants and Care Setting Ambiguity New denial types are emerging around SDoH factors such as housing instability and unclear categorization of care environments (e.g., emergency vs. urgent care). Top Rated Vendor: Socially Determined
Black Book's 18 Universal KPIs for Complex AR Evaluation
Black Book's qualitative KPIs for evaluating complex AR vendors include specialized claim expertise, regulatory knowledge, recovery effectiveness, client responsiveness, and transparent reporting. Key factors also involve accurate payer identification, workflow flexibility, staff credentials, and quality appeal documentation. Additionally, proactive denial management, consistent recoveries, empathetic patient engagement, timely recovery actions, client-specific adaptability, ethical standards, negotiation effectiveness, and strong client retention rates are critical components.
"These indicators provide the foundation for selecting and retaining the right vendors to manage the revenue that too often gets written off," Brown added.
About Black Book Research
Black Book™ is the healthcare industry's leading independent source for polling, surveys, and performance benchmarking of technology, consulting, and outsourced services. Since 2011, Black Book has surveyed more than 3.3 million healthcare users and executives across 800+ sectors, publishing transparent and vendor-neutral rankings. No vendor or consultant pays for placement. Gratis industry reports are available for download at www.blackbookmarketresearch.com. Licensing information on competitive vendor report scorecards may be requested through contacting research@blackbookmarketresearch.com.
Source: Black Book Research
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