The Billion-Dollar Blind Spot in Healthcare

Key Facts (At-a-Glance)

• The blind spot: Significant revenue loss can occur after an EHR go-live, when documentation and billing errors are most likely to happen and least likely to be detected.
• Extreme case: One large health system recovered close to $1 billion in revenue after Healthrise identified more than 400,000 patient encounters that were never closed following its EHR go-live.
• Root cause: In systems such as Epic, an encounter that is not closed never reaches coding and is never billed.
• The clinical-revenue connection: Healthrise aligns clinical documentation with the revenue cycle, so the care a provider delivers is the care the organization is paid for.
• Patient impact: Accurate documentation and coding protect patients from incorrect bills and the stress that comes with them during recovery.
• The fix: Operational readiness, provider support and at-the-elbow expertise, built into the implementation from the start.

FARMINGTON HILLS, Mich., Aug. 03, 2026 (GLOBE NEWSWIRE) — Months after a large health system completed an electronic health record (EHR) go-live, its finance team identified a major revenue shortfall it could not explain. Healthrise traced the problem to more than 400,000 patient encounters that had never been closed in the new system, leaving the associated charts unbilled. After the firm worked with physicians to close them, the organization recovered close to $1 billion in revenue and returned to stable financial footing within about two months.

The case is an extreme example of a problem that reaches hospitals of every size. As health systems operate on margins as thin as 1% to 2%, revenue routinely leaks through claims that are never submitted or are denied after submission. Much of it originates after go-live, when clinicians and staff are still adapting to a new system and it is often difficult to detect until it becomes a significant accounting event.

These losses frequently begin with incomplete documentation and unclosed encounters. In platforms such as Epic, an encounter must be formally closed before a visit moves to coding and becomes a billable claim. When that step is missed, the chart remains open and the revenue is never captured. A single open encounter has limited effect, but across thousands accumulating from the first day of go-live, the financial impact quickly compounds.

The root cause lies in the relationship between clinical work and reimbursement, which many organizations manage as separate functions. A claim depends on what happens during care. Healthrise, a healthcare consulting and technology firm, was built to connect those clinical actions with the revenue cycle. It works with providers, coders and billing teams together so the care delivered is the care that gets reimbursed.

Jodie Hilliker is Senior Director of EHR Services at Healthrise, where she leads the clinical division and its work linking patient care to the revenue cycle. A clinician by background, she has overseen more than 425 Epic implementations. The most consequential errors she encounters, she said, are operational rather than technical.

“Go-live is the midpoint, not the finish line,” Hilliker said. “Most of the financial risk in an implementation surfaces after the system goes live, in the daily work of the people using it.”

The solution for many is more software training, but that doesn’t address the root cause. Instead, Hilliker advises operational readiness be baked into the implementation budget from the outset. Healthrise works one-on-one with physicians to tailor workflows, templates and order sets to how they practice, which reduces frustration and improves system adoption. Its at-the-elbow specialists stay beside staff through go-live to resolve issues as they arise.

When documentation or coding is wrong, the error can reach a patient as an inaccurate bill at the worst possible moment, often during treatment for a serious illness. Correcting the clinical record at its source spares that stress and lets patients focus on recovery.

The gaps are notable given the industry’s growing emphasis on artificial intelligence (AI). More than 40% of providers now report denial rates of 10% or higher, according to Experian Health’s 2025 State of Claims survey, with incomplete documentation cited as the leading cause. Two-thirds believe AI can improve the claims process, but only 14% currently use it to reduce denials.

“AI can draft a letter. It is not ready to repair a revenue cycle that was never built correctly,” Hilliker said. “The basics still determine whether an organization gets paid.”

Healthrise begins each engagement with a comprehensive on-site assessment designed to uncover hidden sources of revenue leakage. Through an in-depth review of provider workflows, clinical documentation and EHR utilization, Healthrise identifies the underlying causes of coding and billing inaccuracies. The company then delivers targeted provider education and workflow optimization to improve documentation quality, strengthen coding accuracy and prevent recurring revenue loss.

At a large health system in Northeast Florida, the approach resolved more than 60,000 un-indexed clinical documents and reduced the denial rate by 6%, a $2 million net financial impact, within four months.

To learn more about Healthrise’s EHR services, operational readiness and go-live support, visit www.healthrise.com.

About Healthrise

Healthrise is a healthcare consulting and technology firm that helps hospitals and health systems strengthen both their financial and clinical performance. Founded in 2012, the company supports clinicians and end users before, during and after EHR implementation to help organizations reduce revenue leakage, improve satisfaction and protect the patient experience. Healthrise has supported more than 25 health systems and managed over $35 billion in net patient revenue. For more information, please visit www.healthrise.com.

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Trysten Loos
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