Fighting Denials and Leading with Purpose in Healthcare with Ed Norwood

Summary

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Becker’s Healthcare Podcast: “Fighting Denials and Leading with Purpose in Healthcare”

Guest: Ed Norwood, CEO of ERN Enterprises, author of Be a Giant Killer
Date: March 29, 2026
Host: Becker’s Healthcare

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Episode Overview

In this insightful episode, Becker’s Healthcare welcomes Ed Norwood, a seasoned healthcare advocate, CEO of ERN Enterprises, and author of Be a Giant Killer. The discussion centers on combating payer denials, the evolving regulatory and AI landscape in healthcare, leadership lessons, and cultivating expert teams to adapt and thrive. Ed combines policy acumen with deeply personal stories, offering strategic and motivational advice for today’s—and tomorrow’s—healthcare leaders.

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Key Discussion Points and Insights

1. Ed Norwood’s Background and Mission

• Introduction to ERN Enterprises and Their Work
  • ERN advocates for patient access by helping providers navigate and challenge improper denials using administrative law and regulatory expertise.
  • Example: Successfully overturned an ERISA plan’s denial to secure brain tumor surgery for a 17-year-old (00:12–01:58).
  • Quote:

    “We have a proprietary appeals technology with appeal libraries, regulatory law templates that we're converting to an AI platform to provide regulatory intelligence.” (01:47)

2. Be a Giant Killer: Leadership Through Personal Growth

• Ed’s Book and Inspiration
  • Focuses on breaking generational cycles and leading without perpetuating past traumas.
  • Quote:

    “It’s a book on leadership, how to eliminate generational giants that bleed into your marriage, relationships, your work—to make sure you are leading, not bleeding in the workplace.” (02:58)

3. Industry Trends: Prior Authorization, AI, and Legislative Change

• Emerging Trends Identified
  • CMS prior authorization rules and the adoption of AI/automation in payer denials (03:47).
  • Key legislation: California SB 1120 and 2024 CMS memos aiming to ensure medical decisions involve qualified clinicians, not just algorithms.
  • Quote:

    “There’s a bit of underground resistance with AI … but we really can’t avoid it. AI will handle repetitive high-volume tasks that slow us down … but professionals will need to evolve into human experts.” (05:01)

4. Technological Innovation: Rev Assurance and Rev AI Platforms

• Recent Achievements and Growth
  • Expansion of ERN’s Rev Assurance technology—a resource hub for appeals and denials.
  • Developing Rev AI, an intelligence platform to predict denial risk and automate appeals with built-in regulatory oversight (06:04–08:31).
  • Notable Win: Used the platform to secure $6 million settlement and hardwired specific payer behaviors into contract terms (07:42).
  • Quote:

    “The money is one thing, but … we were able to negotiate new contract terms as part of the settlement.” (07:42)

5. Strategic Policy Engagement and Industry Impact

• CMS Clarification and Its Impact
  • New guidance: MA plans are financially responsible for services if they fail to respond to post-stabilization requests within one hour.
  • ERN now uses this for case reopenings, enabling favorable remediation before regulatory escalation (09:06–10:54).
  • Advice: Connect with Ed on LinkedIn for access to the CMS policy documentation.

6. Advice for Evolving Leaders

• Building Culture with Purpose
  • Leaders should intentionally shape organizational culture and train teams to become subject matter experts.
  • Shift from traditional credentials to true proficiency and the ability to adapt (the “pivot”) in response to industry change (11:04–16:43).
  • Quote:

    “If the industry is changing but we are remaining the same, we will eventually become extinct. At EARN, we’re constantly mastering the art of the pivot.” (14:56)

  • The Five I’s Exercise for Leaders:
    1. Inspiration—Who inspires you and why?
    2. Impact—What is your work’s impact?
    3. Incident—What key incidents shaped you?
    4. Influence—What systems have you influenced?
    5. Interesting—What’s most interesting about you or your work?

7. Closing Reflections

• On Trust, Permission, and Authority
  • Building long-term credibility and being a resource for others leads to opportunities to “shine as an authority in your industry and workplace.” (16:49)
  • Quote:

    “We have spent 25 years building a culture, giving our lives away, expecting nothing in return, showering people with unexpected generosity. … When you become a resource to people, people will trust you and they will give you permission to do your finest work, to shine as an authority...” (16:49–17:36)

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Notable Timestamps

• 00:12 – 01:58: Ed Norwood’s background & ERN’s advocacy approach
• 02:58 – 03:41: Inspiration and content of Be a Giant Killer
• 03:47 – 05:58: Key trends: CMS, AI, California law
• 06:04 – 09:00: Technological innovation and $6M contract win
• 09:06 – 10:54: CMS clarification on prior authorization and reopening denials
• 11:04 – 16:43: Advice for leaders: intentional culture, subject matter expertise, “the art of the pivot,” Five I’s
• 16:49 – 17:36: Final reflections on authority and building culture

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Memorable Quotes

• “AI will handle repetitive high-volume tasks that slow us down … but professionals will need to evolve into human experts to make sure the AI doesn’t drift.” (05:01, Ed Norwood)
• “If the industry is changing but we are remaining the same, we will eventually become extinct.” (14:56, Ed Norwood)
• “When you become a resource to people, people will trust you and they will give you permission to do your finest work, to shine as an authority in your industry and in your workplace.” (16:49, Ed Norwood)

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Summary Takeaways

Ed Norwood’s perspective weaves regulatory savvy, technological foresight, and leadership coaching into a vital prescription for healthcare’s future. He advocates for smart, proactive denial management, the strategic integration of AI with human expertise, and the cultivation of cultures where expertise and adaptability are core. His call to lead with purpose—both in operations and in personal growth—provides practical and motivational guidance for anyone navigating today’s complex healthcare landscape.

Transcript

[A]

Hello and welcome to the Becker's Healthcare Podcast. I'm joined today by Ed Norwood. He is the author of Be a Giant Killer and CEO of ERN Enterprises. Ed, can you tell us a little bit about yourself and your organization?

[B]

Hey, thank you Jeremy. Just thrilled to be on the platform and for the opportunity. Really just want to applaud Scott for everything that he does at Beckers to really inspire leaders to transform health care. I am a husband, a father who also moonlights as the chaplain for NFL Agency. But my day job is as an advocate and CEO of Earned Enterprises. We are an advocacy, consulting and technology firm that provides training for healthcare providers how to advocate for medically appropriate care by identifying, citing and applying critical administrative laws to overturn improper denials and preserve patient access to care. Quick example about that. About a year ago we had a 17 year old boy with a brain tumor that would cause him to have seizures, fall to the ground, dislocate his shoulder. A team of neurosurgeons wanted to remove the tumor, but his ERISA plan would only authorize a biopsy. We got involved on a Saturday, worked till sudden early Sunday morning, challenged that the plan reviewer was not competent. In other words, Germany. They did not have the appropriate training and experience in the field of medicine to evaluate or deny that claim under a federal law 29 CFR 2560.5031h. We gave the plan an opportunity to resolve it before we filed a regulatory complaint and by Monday it was overturned. The young boy received the surgery and is doing really, really, really well now. And so we've kind of created an entire business model around this concept. We have defensible IP that helps us assist providers with regulatory claims representation, clinical denial prevention to capture authorizations while the patient's still in house, regulatory training, consulting, pre litigation. And we have a proprietary appeals technology with appeal libraries, regulatory law templates that we're converting to an AI platform to provide regulatory intelligence. And so we're just thrilled to have been doing this for 25 years. And with great organizations like Becker's, government agencies and law firms, we've been able to work towards a mission of really defending the healthcare delivery system in the nation.

[A]

And so you also wrote the book Be a Giant Killer. Can you tell us a little bit about that book and what inspired you to write it?

[B]

Yeah, we. You know, I wrote that book after years of realizing that there are many things that we carry from our childhood into our adulthood. And I begin to experience that if I didn't deal with some of the fears, the traumas that I had growing up, I could perpetuate them to my children. So really it's a book on leadership, how to eliminate generational giants that bleed into your marriage, to your relationships, to your work to make sure that you are leading, not bleeding in the workplace.

[A]

Awesome. And now back to healthcare. What trends are you currently paying attention to?

[B]

Two of the biggest trends that we're watching now are CMS prior authorization rules and number two, the rapid growth of AI and automation in payer denials. And we're seeing regulators step up. For example, in California, SB 1120 added health and safety code section 1367 to make clear that a medical necessity determination, a decision cannot be made solely by an algorithm or supplant healthcare provider decision making. A licensed competent clinician has to be involved clinical history and patients. Individual circumstances must be considered and this followed Jeremy a cms memo in 2024 that required that MA plans do the same. This creates a new dynamic for providers. Payer denials are getting more automated and complicated and providers need smarter tools to keep up at earn. We're trying to stay on top of it. We're constantly monitoring the legal landscape to ensure that plans are adhering to new and existing insurance protections. We also are currently in the process of overhauling our appeals and training technology to build the AI platform I spoke about earlier to really ensure compliance and assist providers with their UN appeals process. There's just in closing, there's a bit of underground resistance with AI. You know, will I lose my job in the future with AI? With revenue cycle folks, AI brings a lot of anxiety, but we really can't avoid it. AI will handle repetitive high volume tasks that slow us down and people. Professionals will need to evolve into human experts to help identify knowledge gaps to make sure the AI doesn't drift. Because while computers are the bicycle of the mind, AI is the car of the mind.

[A]

And so what would you say over the last six to 18 months or so that you're most proud of?

[B]

Over the past year we've seen strong growth in our existing Rev Assurance online technology platform, which is an appeal letter library and resource hub for clinicians and revenue cycle teams. That traction has been an important signal for us. It confirms that providers are actively looking for better technology to manage denials and strengthen their appeals process. Building on that momentum, our focus is now Rev AI, our next generation intelligence support platform for the appeal process. We began development earlier this year and it's going to help revenue cycle teams move faster, respond to denials more strategically it's designed to analyze claims and supporting documentation, predict likely denial risk, classify jurisdiction and payer behavior and misconduct, and support automated appeal generation and submission, all while keeping human oversight in the loop and limiting costly litigation. The platform is designed to help organizations better understand claims, contacts, surface likely denial drivers, and support more targeted defensive appeals. We're still early in the building phase of that, but those the signals so far are very encouraging and we really believe that it will meaningfully strengthen how organizations approach denial recovery and defend the rights of patients to to remain in hospitals. Just about six months ago we used this proprietary tool to secure a $6 million settlement for one of our providers. And the money is one thing, but what I loved about this was we were able to negotiate new contract terms as a part of the settlement. The plan must adhere to the 2 midnight CMS benchmark. We got that into the contract. The plan must adhere to responding within one hour to an authorization request per 42 CFR 422.113. They must adhere to reimbursing ER payments per the prudent layperson standard, not considering the final but the presenting diagnosis of the patient. They must ensure that they don't conduct retrospective authorization denials to rescind those authorizations after the provider is treated. In good faith and I love this one, we got them to incorporate in the contract to adhere to using Sepsis 2 criteria for Postpay clinical review and DRG validation instead of the restrictive sepsis3 that has been problematic in the industry. So we're quite excited about that.

[A]

Awesome. And what would you say you're currently most focused on or excited about over the next year or two?

[B]

You know, around the time that we got the 6.2 settlement, we had submitted some legal inquiries to CMS and we were able to get them to clarify. And this is big because with many of the prior authorization issues that exist, we feel this will be groundbreaking for many of our providers. We were able to get them to Clarify that under 42 CFR 422.113, an MA plan becomes financially responsible for any post stabilization services that are rendered by a provider if the plan is not responded within one hour of the request by the hospital to the MA organization. And they were able to mention in this policy decision that these requirements apply to both contracted and non contracted facilities. We're now issuing reopenings on all improper denials for this reason where we can prove we called you on January 15, you failed to respond within one hour. We sent you clinicals on the 16th, the 17th, the 18th and the 19th patient was discharged on the 20th without any disapproval by you, leaving you financially responsible for the entire state. We're now issuing reopenings which are distinct from the appeals process to allow plans to remediate the issue before any regulatory complaint filing escalation. I will provide listeners after this podcast with a copy of that decision on LinkedIn, so I really encourage them to connect with me through LinkedIn so they can get a copy of that and incorporate on, you know, at least assimilate that in their, their appeals moving forward.

[A]

All right, and as we start to close out, what advice would you have for younger, evolving leaders?

[B]

That's a great question. Build culture with intentionality. You know, culture is simply this is what we will do, this is what we will not do. With the accelerating pace of AI advancements, the future of insurance and revenue cycle management is being shaped in unimaginable ways. In response, we must, as leaders, incorporate regulatory shifts directly into our models by training employees into autonomous subject matter experts who can collaborate, who can mentor and become proficient human experts in an AI driven world. That word proficient simply means this to consummate skill with command. Michael Jordan, arguably the greatest to ever play basketball, hired expert trainers to become proficient or the best in his generation. And if you're listening to this podcast today, we my questions are simply this. Who consults with you? What advice do you give that transforms lives, systems, departments and organizations? No matter what your job title is, what is your expert title? If you're in healthcare revenue cycle, do you tell people that you're a seasoned revenue cycle professional or a subject matter in Medicare Advantage laws? In other words, what can you do that no one else can do? I used to work for Jeremy, a guy by the name of Jay Abraham, when I was 18, and I'm working with his marketing consultant, who's also worked with Jack Canfield and an author that wrote Jesus CEO and some other large motivational speakers and she worked with them to reproduce 40,000 Jay Abrahams, 40,000 Jack Canfields, and she wants to generate 40,000 Ed Norwoods. Personally, I don't know if my wife wants 40,000 ads out there. She can barely handle the one that she actually has. But as this marketing consultant expert kept talking to me about reproducing myself, all I could think about was my staff and the people that I've been entrusted to train and mentor and shape for society. All I kept thinking about was how I can make them subject matter experts in healthcare, in law, in justice, in leadership, in analytics, in character in influence and reproduce that to a thousand generations to make sure that what is in them outlives them. And I believe that for leaders, a pivot is coming. Education and degrees are not enough. Tenure will not be enough. We need to build a proficiency in something that we can sell or that can be automated. Number number two, I would tell them to master the art of the pivot. Healthcare leaders master the art of the pivot. In a business context, that simply means to completely change the way one does something. And I pose this to you. If the industry is changing but we are remaining the same, we will eventually become extinct. At earn, we're constantly mastering the art of the pivot. The six million dollar settlement I shared with you earlier, Jeremy, was a process of two and a half years of pivoting. The reopening process I shared with you that we're now engaged in. Since the CMS policy, it's been a pivot from the appeals process. Our mission that we've established here EARN is we fight for providers and protect patient access when payers deny medically necessary care. And we do that even when there's no overturns, by building and protecting the administrative record, no matter what. We may not win every case, but we fight each case as if we had never lost. And so I think for evolving leaders, number one, I think it's important to shift to a subject matter expert. Number two, master the art of the pivot. And in closing, I'll leave a great exercise for leaders. I call it the five Eyes. And when answer these questions, who is your greatest inspiration and why? What is the impact number two behind your work? Number three, what incident shaped who you are today? They say that policies are organizational scar tissue. Number four, what systems have you influenced significantly? And number five, what is interesting about you? That's the five eyes and when inspiration impact incidents that shaped you, systems that have influenced you. And the most interesting thing about you in your industry. I believe that these five eyes and WIN will shape our why in healthcare and accelerate our wins in the same.

[A]

Well, Ed, I want to thank you again for joining us today on the Becker's Healthcare podcast. Do you have any final thoughts you'd like to leave for our listeners?

[B]

No. You've been quite amazing. Thank you for just the opportunity to just spend this time with me. We have spent 25 years building a culture, giving our lives away, expecting nothing in return, showering people with unexpected generosity. Because I've learned that to do anything in life, we need trust, permission and authority. And when you become a resource to people. People will trust you and they will give you permission to do your finest work, to shine as an authority in your industry and in your workplace. Build that for 20, 26 and years beyond perfect.

[A]

Well, Ed, thank you again for joining us today. You have a lovely rest of your day.

[B]

Hey, thank you. Appreciate you.