EVC LLC’s AI-Powered Strategy for 2026: Protecting Revenue and Operations
EVC LLC’s AI-Powered Strategy for 2026: Protecting Revenue and Operations
The end of the year marks a critical window for healthcare providers to implement strategic actions against the converging financial, regulatory, and payer challenges anticipated in 2026. Elevate Vets Consulting LLC (EVC), leveraging its Veteran-Led, Clinical Expertise, and AI Technology-Driven approach, is uniquely positioned to help your organization shift from reactive defense to proactive, data-driven revenue protection, with autonomous coding solutions.
CHALLENGE AREA I: Mitigating Payer Scrutiny & Denials
Payer challenges, particularly around authorization and denials, represent the most immediate threat to cash flow in 2026. Payers are mandated to speed up decision times, increasing the risk of denials for "non-compliant submissions".
| Action Providers MUST Take | EVC's AI-Driven Solutions - Powered by SensaServices.AI (Sensa) Data Analytics |
|---|---|
| Modernize Prior Authorization (PA): Adopt Electronic PA (e-PA) tools to integrate with payer APIs for more accurate communications. | AI-Powered Pre-Approval/Pre Certification: Sensa offers this feature to significantly reduce processing time and meet faster processing timelines mandated by new Center for Medicare and Medicaid Services (CMS) Final Rules. |
| Utilize Predictive Analytics: Invest in AI to score claims before submission, shifting staff from appeals to error prevention. | Proactive Denial Prevention: EVC provides advisory support and utilizes Sensa's platform with 18 versions of Claim Scrubbers to identify probable errors before submission, moving you to front-end error prevention. |
| Strengthen Appeals: Address denied claims quickly and effectively – Avoid need for Appeals. | Effective Denial Appeals & Arbitration: Sensa's AI Denial Processing uses historical trends for more successful resubmissions13. The AI Powered Arbitration Module reports success in getting paid more than the Arbitration Qualified Payment Amount (QPA) 82% of the time. |
CHALLENGE AREA II: Protecting Financial Margins Against Cuts
With likely reductions to the Medicare conversion factor and Protecting Access to Medicare Act of 2014 (PAMA) cuts (up to 15% for labs), protecting revenue against stagnant commercial rates is vital for 2026.
- Financial Tracking and Insight: EVC LLC provides Executive level and/or RCM Team Advisory support. Sensa's analytics feature tracks collections against contracts and fee schedules, spotting variances and opportunities to increase revenue. This data is essential for aggressively negotiating rates that reflect the true cost of care for 2026.
- Revenue Recovery and Optimization: EVC delivers Claims denial analysis and reduction strategies tailored to specific primary care or specialty practices. Sensa's AI performs Autonomous Coding Optimization to identify under-reimbursed in-network claims and reveal optimal CPT/diagnosis code combinations for out-of-
network claims by payer.
- Proven Financial Results: The integrated approach demonstrates an ability to drastically improve financial health. Average results of using Sensa AI-driven tools:
- 39% reduction in Accounts Receivable (AR).
- Reduced Days Outstanding (DSO) from 65 to 28.
- Increased overall client revenue by over 18%.
CHALLENGE AREA III: Enhancing Efficiency, Compliance, and Workforce Readiness
To combat staffing shortages and stricter regulatory/payer requirements, EVC blends clinical expertise with technology to ensure compliance and efficiency.
- RCM Staff Efficiency: EVC provides AI-driven billing workflow optimization and implements Sensa's RCM Apps to automate and centralize management, providing
productivity dashboards to track staff load and utilization. This automation has led to a reduction in labor costs by over 35%.
- Clinical & Documentation Compliance: EVC, supported by Dr. Cheryl Garmon's DNP, RN, CASC expertise, guides providers to Intensify Clinical Documentation Improvement (CDI). The Sensa AI Modules for Payments verifications and Predictive denial review drive accuracy, helping providers ensure clinical documentation aligns with submitted codes to withstand audit and price transparency scrutiny. EVC also offers Ambulatory Surgery Center (ASC) Operations and Compliance and Surgical/Perioperative Services Consulting support.
- Workforce Readiness & Credentialing: EVC offers dedicated Credentialing and Onboarding Services per Payer. Our experts handle every phase, including Council for
Affordable Quality Healthcare (CAQH) profile setup and maintenance and Medicare, Medicaid, and commercial payer enrollment, to help healthcare organizations activate revenue faster and avoid delays in onboarding.
By automating RCM from claims to collections, providing advanced analytics, and integrating AI into appeals, EVC LLC offers a comprehensive toolkit, bolstered by
certified clinical expertise, to help your healthcare organization navigate the complex and financially challenging landscape of 2026.
Interested in partnering with a Veteran-Led, Clinically Expert, AI-Powered solution?
Contact Elevate Vets Consulting LLC to schedule a personalized demo and capability discussion:
Ray C. Rogers, President/CEO
Office: (469) 252-1232
Email: ray@elevatevetsconsulting.com
Website: www.elevatevetsconsultingllc.com
Contact Elevate Vets Consulting
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Phone:
(469) 252-1232
Email:
ray@elevatevetsconsulting.com
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Serves clients across Texas and beyond