Epic Resolute Denials Management: Proven Strategies to Reduce Write-Offs by 20%+

Revenue cycle performance has become a top priority for hospitals and physician groups, as they face increasingly tight margins. Epic Resolute plays a central role in managing billing and claims, yet many organizations still struggle with rising denial rates.

Denials are more than administrative setbacks. They directly affect cash flow, patient satisfaction, and compliance. For some hospitals, unresolved denials account for 20–30% of revenue leakage. Too often, these end in write-offs that erode margins.

The good news is that with structured workflows, automation, and consistent denial tracking inside Epic Resolute, providers can cut losses and recover revenue that would otherwise be written off. In fact, hospitals using proven denial management strategies have reported reductions in write-offs of 20% or more.

I. What is Epic Resolute?

A. Overview

Epic Resolute is Epic Systems’ billing and revenue cycle management platform. It is designed to manage claims, collections, and patient billing across both inpatient and outpatient settings. Hospitals and physician groups use Resolute to capture charges, submit claims, follow up on denials, and ensure compliance with payer rules.

What sets Resolute apart is its seamless integration with Epic’s electronic health record. Because the platform is embedded within the same ecosystem, providers can connect clinical documentation directly to billing workflows. This reduces errors that typically arise when clinical and financial systems operate separately.

B. Professional Billing (PB)

Epic Resolute Professional Billing is focused on the needs of physician practices, outpatient departments, and ambulatory care. It supports billing for professional services, ensuring that documentation from visits, procedures, and encounters is accurately translated into claims.

Key functions include:

1. Charge capture linked to physician notes and orders.
2. Claim edits to correct coding errors before submission.
3. Automated eligibility verification for outpatient services.
4. Tracking of reimbursement cycles for practices and ambulatory clinics.

Professional billing helps practices reduce front-end denials by ensuring claims are clean before they are sent to payers. It is especially valuable for multispecialty groups that need consistent coding and billing oversight across providers.

C. Hospital Billing (HB)

Epic Resolute Hospital Billing is designed for inpatient and facility-level billing. It manages complex claims associated with hospital stays, surgeries, and ancillary services.

Core capabilities include:

1. Consolidated billing for room charges, procedures, medications, and ancillary care.
2. Compliance checks with Medicare and Medicaid guidelines.
3. Integrated workflows for prior authorizations and pre-certifications.
4. Tools for managing both government and commercial payer contracts.

Hospital billing is built to handle the scale of hospital operations. It streamlines coordination between clinical staff, coders, and the billing office to ensure claims are accurate and submitted within deadlines.

D. Role in Denials Management

Both the professional billing and hospital billing modules of Epic Resolute play a direct role in preventing and resolving denials. The system enables hospitals to apply pre-claim edits, monitor claims in real-time, and set up work queues that route denials to the appropriate team. This shortens follow-up times but also helps prevent write-offs that typically occur when claims go unresolved.

II. Unique Features of Epic Resolute

A. Seamless EHR Integration

Epic Resolute is not a standalone billing application. It is fully integrated within Epic’s electronic health record, creating a direct link between clinical documentation and financial workflows. Physicians, coders, and billing teams work off the same record, reducing the chance of errors from manual entry or disconnected systems. This integration improves both charge capture accuracy and compliance.

B. Dual Modules for Professional and Hospital Billing

One of the most distinctive aspects of Epic Resolute is its dual-module design. The Professional Billing module serves outpatient and physician practices, while the Hospital Billing module supports inpatient and facility claims. Having both modules within one platform enables organizations that operate across various care settings to manage billing consistently, without relying on multiple vendors.

C. Granular Denials Workqueues

Resolute allows hospitals to design work queues that automatically route denied claims to the right department or specialist. This reduces delays in follow-up and prevents claims from being overlooked. Work queues can be configured by denial type, payer, or dollar amount, providing revenue cycle leaders with flexibility in managing staff workloads.

D. Denial Prevention Tools

The platform includes preventive checks that catch errors before claims reach payers. Real-time eligibility verification confirms coverage, and authorization tracking ensures pre-approvals are in place. Claim edits flag missing or incorrect codes. These tools help lower the number of denials that reach back-end teams.

E. Advanced Analytics and Reporting

Epic’s Reporting Workbench and SlicerDicer tools provide detailed insights into denial patterns. Hospitals can identify top denial reasons, monitor payer-specific trends, and track write-off volumes. The availability of this level of reporting within the billing platform itself reduces the need for separate analytics systems.

F. Compliance and Audit Support

Resolute includes built-in compliance rules that align with HIPAA and CMS guidelines. Claims are automatically screened against payer-specific requirements, helping reduce compliance-related denials. Audit trails document every step of the billing process, which supports both internal reviews and external audits.

G. Scalability Across Hospital Sizes

The system is designed to support both mid-sized hospitals and large health systems. Smaller hospitals benefit from standardized billing workflows, while larger organizations leverage their ability to manage high claim volumes and complex payer mixes. This scalability enables Resolute to adapt to various provider environments.

III. Pros and Cons of Epic Resolute

A. Pros

1. Comprehensive claims and billing automation: Epic Resolute covers the entire billing cycle, from charge capture to collections. Its automation features reduce manual errors and free up staff time for higher-value activities. For organizations with high claim volumes, this automation is crucial for maintaining efficiency.
2. Strong integration with EHR workflows: Because Resolute is part of the Epic ecosystem, it draws directly from clinical documentation. This reduces the risk of mismatched data between the medical record and the billing system. For providers, the result is fewer rejected claims and stronger compliance.
3. Detailed reporting and analytics: The Reporting Workbench and SlicerDicer give revenue cycle leaders a clear picture of denial trends, payer behaviors, and write-off patterns. Having these tools built into the system reduces reliance on external analytics platforms and helps leadership act quickly on performance gaps.
4. Scalable for hospitals of different sizes: Resolute works for both mid-sized hospitals and large multi-site health systems. Smaller hospitals can benefit from standardized billing workflows, while larger systems can leverage their ability to manage complex payer mixes and high claim volumes.

B. Cons

1. High implementation and maintenance costs: Epic Resolute is often viewed as one of the most expensive billing platforms to deploy and maintain. Licensing, training, and ongoing optimization require significant investment, which can be challenging for hospitals operating with narrow margins.
2. Steep learning curve for staff: Staff training is critical, as Resolute introduces new workflows and requires familiarity with Epic’s broader system. Hospitals may face initial productivity dips until teams become proficient with the platform.
3. Customization complexity: While the system is highly configurable, tailoring it to an organization’s unique needs can be a complex process. Incorrect configurations or underutilized features may prevent hospitals from realizing the full value of the platform.
4. Ongoing optimization requirements: Even after go-live, Resolute requires continuous oversight and refinement. Denial trends, payer rules, and compliance requirements change frequently, which means hospitals need dedicated revenue cycle teams to keep the system updated and effective.

IV. Why Denials Happen in Epic Resolute

Even with a robust billing platform like Epic Resolute, denials continue to be a common challenge for hospitals and physician groups. The reasons are often less about technology and more about gaps in process, training, and payer communication. Understanding these causes is the first step toward reducing write-offs.

A. Coding Errors

Incorrect or incomplete coding is one of the most common reasons for denials. Even small mistakes, such as missing modifiers or mismatched diagnosis and procedure codes, can result in claims being rejected. While Resolute’s claim edits help flag issues before submission, coding errors can still slip through when documentation is incomplete or when staff are not fully aligned with current coding guidelines.

B. Eligibility Verification Gaps

Front-end denials often occur when patient insurance information is inaccurate or outdated. If coverage is not verified in real time, claims may be submitted for patients who are not eligible under the plan on the date of service. These denials are preventable but remain costly because they often require multiple resubmissions and follow-up with patients.

C. Prior Authorization Issues

Many payers require prior authorization for high-cost imaging procedures, surgeries, or specialty medications. If authorization is missing, expired, or incorrectly documented, the claim will likely be denied. In Epic Resolute, authorizations can be tracked, but failure to link them correctly to claims can result in revenue loss.

D. Late Filing and Timeliness Risks

Every payer has filing deadlines. Missing those deadlines leads to automatic denials that cannot be appealed. Hospitals that lack standardized workflows in Resolute or do not have real-time monitoring of claims at risk of expiration are more vulnerable to this type of write-off.

E. Compliance-Related Errors

Changes in payer rules, Medicare regulations, or state requirements can lead to unexpected denials if workflows are not updated quickly. Even when Epic provides compliance updates, organizations must ensure their billing teams implement them consistently across all departments.

F. Lack of Coordinated Follow-Up

Ultimately, many denials escalate into write-offs primarily due to inadequate follow-up. If denied claims are not routed to the correct team or if work queues are not monitored regularly, hospitals lose valuable days in the resubmission process. The result is revenue leakage that could have been avoided with stronger oversight inside Resolute.

V. Impact of Denials on Hospital Revenue

A. Revenue Leakage from Unresolved Denials

Hospitals lose a significant portion of their revenue each year due to unresolved denials. Industry estimates suggest that 20% to 30% of denials are never worked. When hospitals fail to resubmit claims on time or do not appeal, this lost revenue directly impacts their bottom line. For organizations already operating on slim margins, the leakage can mean millions in unrealized reimbursement.

B. Burden of Write-Offs

Denials that are left unresolved often result in write-offs. While some write-offs are legitimate, such as charity care, many are preventable. When denials escalate to write-offs, hospitals absorb the full cost of care without payment. This not only affects revenue but also distorts financial reporting by inflating uncompensated care totals.

C. Administrative Costs

Denials not only affect revenue, but they also increase administrative overhead. Each denied claim requires staff time to research, correct, and resubmit. According to the American Hospital Association, the average cost to rework a denied claim can exceed $100 per claim. For hospitals processing thousands of denials monthly, this translates into substantial labor costs that reduce overall efficiency.

D. Cash Flow Disruptions

High denial rates delay payments and slow down cash flow. Hospitals rely on predictable payment cycles to meet payroll, pay vendors, and fund clinical operations. When denials create delays, it forces finance teams to manage more aggressively, sometimes drawing on credit lines or reserves to cover routine expenses.

E. Impact on Patient Satisfaction

Denials can also affect patients. When insurers deny claims, hospitals often bill patients directly while the appeals process is underway. This creates confusion, increases patient complaints, and can lead to delayed collections. Patients who experience repeated billing errors are less likely to trust the organization, which can harm reputation and retention.

F. Strategic Risk for Value-Based Care

As more reimbursement shifts toward value-based care models, denial management becomes even more important. Poor denial handling not only reduces fee-for-service revenue but can also hurt performance metrics that determine incentive payments. Hospitals that fail to address denials risk losing ground both financially and competitively.