January Focus: Insurance Collection Trends From 2025

Cale Queen
Jan 19
3 min read

Why Many Clinics Are Losing Control—and How TriStar BI Uses Business Intelligence to Fix It

By January 2025, expect to insurance denials. What surprised them was how difficult those denials are to successfully recover.

Revenue that once could be recovered through follow-up, appeals, or additional documentation increasingly could not. Cash delays stretched. Rework multiplied.

Teams stayed busy while financial performance eroded.

This was not caused by a single policy change. It was the result of compounding shifts in payer behavior and administrative burden. These changes exposed a deeper issue: most clinics are still managing insurance revenue with tools designed to explain losses after they occurred. Clinics do not have the tools needed to prevent the losses before they were submitted.

This is the environment TriStar Business Intelligence was designed to provide.

Did you earn less from insurers in 2025 than prior years? Let's fix it today!

What The 2024–2025 Evidence Shows

The data does not point to a single disruption. It points to persistent, system-level pressure across the revenue cycle.

Denials Are a Condition, Not an Exception. Elevated denial rates have persisted rather than normalizing. For many clinics, denials are no longer episodic cleanup events—they are a recurring operating condition.

Implication: Denials are not the problem to fix. They are the signal that something upstream is failing.

Recovery Is Slower and More Expensive. Denied dollar amounts are higher, appeal timelines are longer, and recovery is less predictable. Even when claims are ultimately paid, the cost of recovery—staff time, rework, and delayed cash—has increased materially.

Implication: More follow-up effort no longer guarantees proportional return.

Revenue Risk Is Being Created Earlier Authorization requirements, documentation specificity, and medical necessity interpretation continue to expand. Payment success is increasingly determined before a claim is ever submitted.

Errors that were once recoverable are now more likely to result in permanent delay or loss.

Implication: By the time denials appear, the outcome is often already decided.

Business Intelligence should drive decision making and not just report outcomes. If your dashboards aren't driving decisions call us today.

Why Traditional Metrics No Longer Protect You

Metrics such as A/R aging, denial rate, and net collections still matter—but they are lagging summaries, not control mechanisms.

When these metrics move, authorization failures have already occurred, documentation gaps are already embedded, and cash delay is already unavoidable. Worse, under the new denial policies these losses maybe permanent.

Visibility without timing is not control.

Insurers are changing the approval processes. Are your systems optimized?

How TriStar BI Uses Business Intelligence to Drive Decisions

At TriStar BI, business intelligence is not a reporting function. It is a decision system.

We use BI to help leaders decide where to intervene, when to act, and what to change—before insurance revenue is lost.

1. Surface Decision-Relevant Signals Early. We identify authorization fallout, first-pass yield erosion, documentation variance, and rework volume before denials spike.

2. Define When a Decision Is Required. We establish operating ranges, decision thresholds, and ownership so leaders know exactly when action is required.

3. Translate Signals into Action Using the Revenue Cycle Management Playbook. The playbook converts BI signals into predefined operational responses aligned to payer behavior.

4. Validate That the Decision Worked. We confirm improvements through measurable changes in authorization fallout, first-pass yield, rework volume, and cash velocity.

5. Stay Engaged to Sustain Control. Without ongoing support, even good decisions decay. We remain engaged to ensure durability.