Stop Revenue Leakage with AI-Powered RCM
The average health system loses $4.9M annually to preventable denials. We build AI that catches coding errors before submission, automates prior authorization, and turns denial management from reactive firefighting into proactive revenue protection.
Revenue Cycle Is Broken by Design
Complex payer rules, constant policy changes, and manual workflows create a system designed to leak revenue at every step.
Denial Rates Keep Climbing
Average initial denial rates now exceed 12%. Each denied claim costs $25-$118 to rework, and 60% of denials are never resubmitted.
Prior Authorization Delays
Manual prior auth takes 2-14 days and requires 34 minutes of staff time per request. Delays cause care gaps and patient leakage.
Coding Complexity Explosion
ICD-10 has 72,000+ codes. Annual payer rule changes and modifier requirements make accurate coding increasingly difficult.
Staff Turnover in Billing
Revenue cycle staff turnover exceeds 30% annually. Training new coders takes 6-12 months to reach proficiency.
Undercoding and Revenue Loss
Fear of audits causes systematic undercoding. The average hospital loses $1.2M per year from procedures coded below actual complexity.
Payer Contract Underpayment
Payers underpay 7-11% of claims versus contracted rates. Most organizations lack the tools to catch and appeal these systematically.
AI for Every RCM Workflow
End-to-end AI that protects revenue from registration through final payment, integrated with your PM/EHR system.
Recover $3.8M in Annual Revenue Leakage
Get a free denial analysis that shows exactly where your revenue is going and how AI can stop the leak.
Impact Across Health System RCM Operations
Composite results from healthcare organizations ranging from 200-bed hospitals to 12-hospital systems.
Where the Revenue Recovery Comes From
Three areas that drive the majority of financial improvement in AI-powered revenue cycle operations.
RCM Compliance & Audit Protection
Our AI codes accurately, not aggressively. Every recommendation is defensible and audit-ready.
Why RCM Teams Choose OpenMalo
We do not just find denials — we prevent them. Our AI catches revenue leakage before it happens.
Get a Free Denial Analysis
Send us 90 days of remittance data and we will show you exactly where revenue is leaking.
Revenue Recovery
12-Hospital System Recovers $3.8M in Year One
A regional health system deployed AI-powered claim scrubbing, coding assistance, and prior auth automation across all facilities.
The Problem
Denial rates exceeded 14% and climbing, costing $5.2M annually. A/R days averaged 52 against a 38-day target, and 40% of prior auth requests were submitted late.
Our Approach: We deployed pre-submission AI claim scrubbing that validated each claim against payer-specific rules and historical denial patterns, automated prior auth submissions for the top 15 procedure categories, and built a coding assistant that suggested and validated codes from clinical documentation in real-time.
Read Full Case StudyWhat Our Clients Say
“Our denial rate dropped from 14.3% to 8.6% in the first 90 days. That is $1.2M in revenue we were just leaving on the table.
“The prior auth automation alone saved 4,200 staff hours in the first year. My team finally has time to work complex accounts.
“We found $400K in payer underpayments in the first month. The contract variance tool paid for the entire annual engagement immediately.
Frequently Asked Questions
Most clients see measurable denial reduction within 30 days of go-live. The pre-submission scrubber catches issues immediately. Full ROI including coding optimization and underpayment recovery typically materializes within the first quarter.
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