Jeff Francis has been a CFO since 2008. He runs a $1.5B net patient revenue system. And right now, the thing keeping him up at night isn't staffing — it's insurers finding new ways to delay and deny. Here's how Nebraska Methodist is fighting back.
The equivalent labor Nebraska Methodist offloaded through AI-powered claim status automation — work that started in 2019 and is now directing human attention toward higher-complexity claims.
Francis put it plainly on a recent Becker's CFO and Revenue Cycle Podcast episode: the biggest shift in revenue cycle right now isn't coming from inside the health system. It's coming from payors.
"The biggest shifts are coming from the denials, the pushback that we're seeing from insurance companies, from the third-party payers. They're getting innovative, they're coming up with new ways to really delay payments, or if at all possible, deny payments."
Nebraska Methodist is a roughly $1.5B net patient revenue system built around four hospitals, 30+ physician locations, a distribution company, and a nursing and allied health college. When a system that size says denial volume is the top operational pressure, it's worth paying attention.
This isn't a compliance problem or an edge case. It's a structural shift in how payors operate — and CFOs are watching it accelerate.
Francis said the biggest ROI isn't coming from front-end fixes or back-end collections. It's in the middle — documentation and coding.
"We're seeing the biggest lift there…the biggest return on investment, because we can have it more accurate, we can get it out sooner and then hopefully overcome some of those delays."
The logic is clean: if your documentation is accurate and your coding is tight, you reduce the surface area payors have to work with. You don't win by fighting more denials — you win by submitting claims that are harder to deny in the first place.
Methodist is using AI on two fronts here:
Both investments have to pass a clear bar: quick and demonstrable ROI. Francis said every technology dollar needs to show a clear return before it gets approved. That discipline is the filter. Not every vendor gets through it.
If the middle of the cycle is where the wins are, the front end is where the grind lives. Francis was candid about it.
"I wish I had the secret sauce. It's just hard work. It's a continuous effort from our leaders, reinforcing training the new hires, and doing everything that we can to do some automation around some of the prior authorization."
Registration accuracy — getting the right information captured at the point of scheduling or intake — remains stubbornly difficult to systematize. Prior auth automation is helping at the edges, but it isn't a silver bullet. The front-end problem is still largely a human-quality problem.
Payor denial innovation is outpacing most health systems' denial management infrastructure. The CFOs who are winning aren't out-litigating denials — they're out-documenting payors before submission. The question for your team: where is your documentation accuracy actually holding up?
Francis also talked about how the CFO seat itself has evolved — from backward-looking financial controller to forward-looking strategic operator.
"The windshield is bigger than the rear view mirror."
That shift matters for RCM because it changes the conversation. CFOs who are running revenue cycle as a cost center are operating in the rear view. The ones positioning it as a strategic lever — where AI investments, documentation quality, and denial prevention directly protect margin — are looking through the windshield.
The Nebraska Methodist playbook isn't exotic. It's disciplined. A few takeaways worth applying:
We track denial trends, AI deployments, payor policy shifts, and operational moves across health systems — so you don't have to monitor 40 sources yourself.
Get the free briefing →Source: Becker's Hospital Review — "The 'biggest shifts' this Nebraska system CFO is seeing in revenue cycle" (June 29, 2026)