Authorization gets treated like a checkbox — secured once at admission, then forgotten until discharge. That's not how payors see it. A patient's clinical status changes daily, and payors expect the documentation supporting continued stay to keep pace. When it doesn't, the authorization on file stops matching the care being delivered, and the gap between the two is exactly where concurrent denials come from.
Concurrent Review Isn't Prior Authorization
The two get conflated constantly, but they happen at different points in the stay and solve different problems:
Prior Authorization
A one-time approval secured before or at admission, confirming the initial level of care is medically necessary.
Concurrent Review
Ongoing, typically daily reassessment during the stay — re-confirming that continued hospitalization is still medically necessary as the patient's condition evolves.
A stay can be perfectly authorized on day one and still generate a denial on day four, if nothing re-certifies that the patient still needs to be there. That's a concurrent review gap, not a prior authorization failure — and it requires a completely different fix.
Why This Category of Leakage Is Growing Fastest
Revenue cycle leaders surveyed by Becker's Hospital Review point to the same pattern: the clinical, level-of-care side of denials is outpacing every other category, and most hospitals aren't built to catch it[1].
"The biggest leakage is the one hospitals can't easily see — clinical overrides by payers. Industry data shows us that denials drove an estimated $48.4 billion in lost hospital revenue in 2025, and the clinical piece of that — including DRG downgrades, medical necessity denials and level-of-care challenges — grew faster than almost any other category. These are the hardest to track and hardest to overturn."
— Wendy Buice, Senior Vice President, Revenue Cycle Partnership Success, Ensemble Health Partners
"Shifting Utilization Review into Revenue Cycle... has allowed us to standardize work across the health system, create more consistent processes, and better align clinical review, documentation, authorization, and reimbursement workflows."
— Angela Confoey, Senior Vice President, Revenue Cycle and CRO, UMass Memorial Health
The through-line: hospitals that keep utilization review siloed from revenue cycle — reviewed weekly, reconciled after the fact — are the ones absorbing this growth. The ones closing the gap are treating continued-stay authorization as a daily clinical-financial function, not a periodic check-in.
The Case for Daily, Not Weekly
"The biggest source of revenue leakage is typically upstream process breakdowns, not downstream billing issues... The greatest value comes from preventing issues before claims are submitted rather than trying to recover revenue afterward."
— Jeff Mincher, Senior Vice President and Chief Revenue Cycle Officer, Texas Health Resources
"Most hospitals focus on denial management, but the real leakage occurs much earlier... Every denial prevented at the front end is far more valuable than a denial appealed on the back end."
— Eric Risedorph, Director of RCM Integration and Client Services, Parkview Health
Weekly review means up to six days can pass between a real change in a patient's condition and the documentation catching up to it. Every one of those days is a day the authorization on file may no longer match reality — and payors are specifically looking for that mismatch during review.
What a Real Concurrent Review Program Requires
- Daily reassessment of every active inpatient and observation case — not a weekly batch review
- Same-day submission to payors when clinical status changes, not held for the next scheduled check-in
- Documentation aligned to the specific criteria set (InterQual, MCG) the payor is actually using
- Active tracking of authorization expiration dates, so coverage never lapses mid-stay
- Physician advisor escalation built in for borderline or disputed cases, not left to case managers alone
This is the exact structure behind bServed's Concurrent Reviews service — see the full breakdown on the Services page.
What This Looks Like in Practice
"This hospital was experiencing significant overutilization of Observation level of care due to inconsistent daily clinical review processes and limited oversight of medical necessity. bServed implemented a structured utilization management workflow — performing daily medical necessity reviews using evidence-based clinical criteria — cutting concurrent denials by 40%."
That result is from bServed's engagement with Hospital 4 — see the full case study, or explore outcomes across all hospital partners on the Results page.
Sources
[1] Becker's Hospital Review, "Big Ideas to Fix Hospital Revenue Leakage From 25 Leaders" — quotes from Wendy Buice (Ensemble Health Partners), Angela Confoey (UMass Memorial Health), Jeff Mincher (Texas Health Resources), and Eric Risedorph (Parkview Health)