Inside RCM: Payer Pressure, Visibility Gaps, and the Reality of 2026
Payer Pressure Is the Primary Driver of Revenue Risk
Payer behavior has overtaken internal constraints as the top barrier to growth. RCM leaders report that payer-driven dynamics, such as reimbursement pressure, adjudication volatility, and denial complexity, now represent the most significant barriers to revenue growth. While staffing constraints and workflow inefficiencies remain real challenges, they are increasingly overshadowed by external forces that limit predictability and control.
This shift marks a departure from prior years, where internal optimization was viewed as the primary lever for improvement. In 2026, revenue performance is increasingly dictated by payer behavior rather than patient volume or internal capacity.
Visibility Gaps Are Forcing RCM Teams into Reactive Mode
Reactive RCM Comes at a High Operational and Financial Cost
Denial-related work is consuming time, resources, and revenue. The operational burden of reactive revenue cycle management is substantial. RCM teams report spending significant hours each week on denial-related work, diverting attention from higher-value activities such as prevention, optimization, and strategic planning.
At the same time, leaders estimate that a meaningful percentage of net patient revenue remains at risk or is lost entirely due to denials, underpayments, and timely filing challenges. Together, these findings underscore the compounding cost of identifying revenue risk too late.
Denials Have Become a Strategic Financial Concern
What was once operational is now discussed at the executive level. RCM leaders increasingly characterize denials not merely as an operational nuisance, but as a significant financial and strategic risk. For many organizations, denial performance is now discussed at the executive level, reflecting its direct impact on margin, cash flow, and forecasting accuracy.
This shift in perception signals growing recognition that denials are symptomatic of broader payer and visibility challenges, ones that cannot be solved through manual effort alone.
Scaling RCM in 2026 Will Require Leverage and Trusted AI
Technology and automation are central to sustainable RCM performance. Looking ahead to 2026, most organizations do not plan to scale RCM through headcount alone. Instead, leaders emphasize the need for operational leverage through technology, automation, and more intelligent workflows.
At the same time, adoption of AI is cautious and intentional. While leaders view AI-enabled capabilities, such as predictive payer insight and automated workflow orchestration, as increasingly important, concerns around trust, governance, integration, and reliability remain central considerations.
What These Findings Mean for RCM Leaders
The findings in this report underscore a fundamental shift in the revenue cycle operating environment. Payer behavior has become the primary source of revenue volatility, introducing uncertainty that traditional staffing models and incremental process improvements can no longer absorb. As a result, RCM performance is increasingly shaped by external forces that limit visibility, predictability, and control.
At the same time, persistent gaps in real-time insight are driving reactive operating models. When revenue risk is identified only after claims are denied or cash is delayed, organizations face both operational strain and financial exposure. Denials, once viewed primarily as a back-office issue, have escalated into a sustained strategic financial concern, one that is now discussed at the executive level due to its direct impact on margin and cash flow.
Looking ahead to 2026, the difference between average and high-performing RCM teams will be defined by predictability and leverage. Organizations that can identify revenue risk earlier, reduce payer-driven surprises, and scale through technology rather than headcount will be better positioned to navigate ongoing reimbursement pressure and deliver more stable financial outcomes.
Real Insights from RCM Leaders
An annual benchmark of revenue cycle risk and readiness based on insights from 100+ RCM leaders.
More data has not translated into real-time insight or control. Despite growing investment in analytics and reporting tools, most RCM leaders report insufficient real-time visibility into payer behavior and revenue risk. Without timely insight, teams are forced to respond after revenue has already been delayed or denied.
This lack of visibility is closely tied to how revenue risks are identified. Organizations with limited confidence in their data are significantly more likely to operate reactively, addressing issues only after financial impact has occurred.
RESEARCH REPORT
Frequent changes to payer adjudication rules
Denials volume & complexity
Payer reimbursement levels & contract terms
In 2025, what were the top 3 factors that most significantly impacted your organization's ability to grow and collect revenue?
48%
45%
43%
In 2026, what are the top 3 factors that you predict will be the biggest obstacles to revenue growth?
Denial and underpayment management
62%
46%
44%
Payer reimbursement pressure
Staffing constraints
Does this align with last year's prediction?
In last year's survey, we asked RCM leaders to predict the top 3 obstacles they'd face in 2025. They ranked Denial Mitigation, Keeping Up with AR Backlog, and Frequent Changes to Payer Adjudication Rules as the top anticipated challenges.
120+
18
RCM Leaders
Specialties
1%
37%
When asked about visibility into RCM data and payer behavior, most respondents reported only moderate confidence, suggesting that while visibility has improved, teams still lack full clarity and confidence in their insights.
On the Fence
Agree or disagree: in 2025, our organization had sufficient visibility into revenue cycle data to understand payer behavior and revenue risk in real time.
38%
Of respondents identified "lack of real-time visibility into payer performance" as a top 3 factor impacting their ability to grow and collect revenue.
Of respondents identified "payer insight and transparency" as the most impactful outcome for AI technology to improve in 2026.
29%
Of respondents identified "centralized visibility across the revenue cycle" as "very important" to their 2026 RCM strategy.
47%
Explore the Findings
Responses From
Across
The majority of respondents said their RCM teams are spending between 51-75 hours per week on denial-related work. That's anywhere between 2600-3900 hours per year, or 162 full days.
51-75 Hours
4
In 2025, approximately what percentage of net patient revenue was at risk or lost due to denials, underpayments, or timely filing limits?
Less than 1%
1%-2%
3%-4%
16
47
28
5%-7%
8%-10%
More than 10%
21
7
Unsure
6
Denial Prevention
32%
28%
20%
Payer Insight and Transparency
Team Productivity
8%
12%
Revenue Predictability
Which of the following outcomes would be the most impactful for AI technology to improve?
Speed to Cash
Of respondents identified "denials and underpayments" as their biggest obstacle to revenue growth in 2026.
62%
Of respondents identified "automated denial follow up and resolution" as a "very important" capability for AI to tackle in their 2026 RCM strategy.
66%
Of respondents reported that the financial impact of denials at their organization is "a strategic concern discussed at the executive level."
36%
What's limiting broader adoption of AI in RCM?
We asked respondents to identify their biggest concern limiting broader adoption of AI in RCM. The majority of respondents identified "integration with existing systems" as their biggest concern. Teams want to be sure that the technology they're bringing in can work seamlessly with their existing RCM tech stack.
Leveraging Technology & Automation
Which of the following best reflects your organization's approach to scaling RCM in 2026?
42%
32%
21%
A Combination of Hiring & Technology
Hiring Additional Staff
5%
Not Scaling
70%
Of respondents identified "real-time revenue intelligence" capabilities as very important to their RCM strategy in 2026.
Stay Ahead of Revenue Risk in 2026
Payer pressure, denial complexity, and revenue volatility are reshaping the role of the revenue cycle team. Staying ahead will require earlier insight into payer behavior, greater visibility into revenue risk, and more leverage across the revenue cycle.
Meet with Adonis to learn how you can:
Gain real-time visibility into payer performance and emerging revenue risk
Identify and address denial drivers earlier—before cash is delayed or lost
Reduce manual effort while improving predictability and speed to cash
Equip your RCM team to operate proactively in an increasingly payer-driven environment
Learn More
How important will automated denial follow up and resolution be to your RCM strategy in 2026?
62%
RCM leaders are entering 2026 in a far more volatile reimbursement environment. Payer behavior has become the primary driver of revenue risk, limiting the impact of staffing increases and incremental process improvements. As adjudication rules change more frequently and reimbursement pressure intensifies, organizations are increasingly exposed to revenue risk they can’t see early enough to prevent.
At the same time, responsibility continues to outpace control. RCM teams are accountable for protecting margin and cash flow, yet most are still stuck operating reactively, identifying issues only after denials occur or payments stall.
Looking ahead, leaders are shifting their focus from reactive recovery to proactive predictability. They’re investing in technology and automation to surface risks earlier, gain actionable insight sooner, and scale impact without increasing headcount. At the same time, AI adoption is being approached deliberately — with an emphasis on trust, governance, and long-term reliability.
Learn more about who took the survey
Organization Type
Specialty
Department
Location
