In 2024, 41% of healthcare providers reported claim denial rates exceeding 10%, up from 30% just two years prior. The average cost of a denied inpatient claim rose 12% year over year (2025).
These aren't anomalies. They're what happens when your revenue cycle workforce is shrinking, burning out, and drowning in complexity, all at once.
If you're running a physician group and still treating your billing staffing shortage as a hiring problem you'll eventually solve, here's the uncomfortable truth: you won't. This is not cyclical. This is structural.
The Staffing Crisis Isn't Cyclical — It's Structural
Between 2022 and 2024, more than 138,000 nurses left the workforce entirely (NCSBN, 2024 — link). That's the clinical side. While this data reflects clinical staff, the same workforce dynamics are playing out across administrative roles, including billing, coding, and RCM.
Your coders, billing specialists, and AR follow-up staff are leaving at comparable rates, drawn to remote jobs in other industries, or burned out by the volume. You've watched it happen on your own team.
The AHA's 2025 Workforce Scan noted a modest dip in burnout for the first time since the pandemic but cautioned that underlying shortages remain deeply entrenched. And the work keeps getting harder: more payer rules, more prior authorization requirements, more sophisticated denial tactics, more regulatory burden from CMS.
The workforce is not returning to pre-pandemic stability. The pipeline to replace them doesn't exist at scale.
Why Hiring More Isn't Solving the Problem
Most physician groups respond to staffing gaps the same way: post more jobs, raise wages, hire agencies. You've probably done all three. The math no longer works.
Here's what the math actually looks like. A 25-provider group faces roughly 1,300 denials per month. At 20 minutes each, that's 433 hours, nearly 3 full-time employees doing nothing but appeals. Few organizations have that capacity.
And with 33% annual billing staff turnover (link), you're constantly replacing the people who actually knew the payer rules, the appeal deadlines, and the quirks of your contracts.
Healthcare employee turnover costs reached $61,110 per nurse in 2025 (link). Even when you do hire, new billing staff need 6–12 months to reach full productivity. During ramp-up, error rates are higher, follow-up cycles stretch, and experienced staff carrying the load are more likely to leave. Hire, train, lose, repeat.
If your cost-to-collect ratio is climbing above 5–6%, this isn't a staffing problem. It's a structural operating model failure.
The Real Impact on Your Revenue
When your billing team is understaffed, the financial damage is specific and measurable:
- Denials not worked (link) within the filing window. Initial denial rates averaged nearly 12% across payers in 2024. Every day a denial sits untouched, recoverable revenue erodes.
- Underpayments not identified (link). Your team doesn't have bandwidth to audit EOBs against contracted rates. Payers pay below contract; your EHR posts it; nobody checks. That's 3–5% of net revenue walking out the door silently.
- AR aging beyond 90 days (link). Slower follow-up pushes receivables past the point of diminishing returns, increasing write-offs and compressing cash flow.
- Rising cost to collect. Agency staff, overtime, and rework drive the ratio up — often without proportional revenue recovery.
The net effect: you're working harder to collect less. And the gap widens every quarter.
3 Moves That Actually Work
Move 1: Make the Work Happen Without Adding Headcount
Status checks, denial categorization, appeal generation, and payment posting: these are the highest-volume tasks in your revenue cycle. They shouldn't depend on whether you can fill a seat. When the mechanical work gets done regardless of staffing, your people focus on judgment calls that actually need a human. Execution capacity that scales — without scaling payroll.
Move 2: Focus on Revenue Assurance, Not Just Denial Management
Most RCM operations are reactive: a claim gets denied, then someone works it. Revenue assurance flips that model, systematically identifying underpayments, monitoring contracted rate compliance, and catching leakage before it ages out. If your team is only chasing denials, you're recovering pennies while dollars slip through undetected.
Move 3: Close the Gap Between Insight and Action
You probably have dashboards showing your denial trends. The question is: does anyone have time to act on them? Most physician groups don't have an analytics problem; they have an execution problem. The ability to move from identifying revenue at risk to actually recovering it, at scale, without bottlenecking on staff availability — that's the gap that needs closing.
What This Looks Like in Practice
The modern RCM operating model doesn't eliminate your team. It eliminates the dependency on headcount as the primary lever for revenue recovery. Every denial, every underpayment, every aging claim gets worked systematically — whether you have 2 billers or 20.
This is the model ANKA was built to deliver. ANKA is the execution layer. It works your denials, recovers your underpayments, and resolves aging AR at scale. No additional billing staff required. It closes the gap between knowing where your revenue is stuck and actually getting it back.
The Staffing Crisis Isn't Temporary. Neither Should Be the Fix.
If you keep treating billing staffing as a hiring problem, you'll keep getting the same results: rising costs, declining collections, and an operating model that breaks under pressure.
The physician groups pulling ahead have accepted the structural reality and rebuilt their execution model accordingly. They're not waiting for the labor market to recover. They're building revenue cycle operations that perform regardless of headcount.
If your revenue is stuck between denial and recovery, between insight and action, the issue isn't your data. It's that the work isn't getting done — consistently, at scale.