Payer denials remain a persistent problem across the hospital industry, but Nashville, Tenn.-based Tenet Healthcare, parent company of ASC chain United Surgical Partners International, isn’t seeing the acceleration that has rattled some of its peers, CEO Saumya Sutaria, MD, said on an April 30 first-quarter earnings call.
“Payer denials — disputes, many of which can result in denials and a back-and-forth — are high. They have been high,” Dr. Sutaria said. “They are too high for what is appropriate, especially when comparing back to pre-pandemic periods.”
But Tenet’s experience diverges from the broader industry narrative, particularly among ASCs, many of whom don’t have the economies of scale needed to leverage payer contracts. The initial denial rate on claims increased from 2.4% to 11.81% between 2023 and 2024, according to revenue cycle data from Kodiak Solutions, derived from more than 2,100 hospitals and 300,000 physicians.
“We’ve seen a clear increase in denials, audits and payment delays over the past year, which mirrors what many physician-led organizations are experiencing,” Andrew Tate, CEO of Hickory, N.C.-based Graystone Eye, told Becker’s. “While diminishing reimbursement continues to create financial pressure, our focus has been on protecting operational stability without compromising care.”
Dr. Sutaria told investors that with regard to denials, Tenet did “not see a meaningful trend this quarter that is different” from last year. The relative stability was attributed to Conifer, Tenet’s revenue cycle management subsidiary, which gives the company a more sophisticated infrastructure for contesting denials, tracking payer behavior and managing collections than most health systems have in-house, Dr. Sutaria said.
While Tenet doesn’t directly credit Conifer with insulating it from the broader deterioration, the company ended first-quarter 2026 with $978 million in adjusted free cash flow, a figure that reflects strong collections performance even in a challenging payer environment.
Payer denials have become one of the most discussed pressure points in healthcare this year, with insurers increasingly pushing back on claims for everything from inpatient admissions to post-acute care.
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