Introduction
Revenue cycle management (RCM) leaders are sounding the alarm on a rapidly shifting reimbursement landscape. According to a new survey conducted by Adonis, an RCM technology company, payer behaviors have overtaken internal operational challenges as the single greatest threat to revenue growth. With more than 120 RCM leaders polled across 18 medical specialties, the findings paint a clear picture: external pressures are now driving financial performance more than staffing shortages or workflow inefficiencies ever did.
Payer Behaviors Overtake Internal Challenges
For years, RCM leaders focused on internal optimization — improving staffing, streamlining workflows, and upgrading technology — as the primary path to revenue improvement. That era appears to be ending.
In 2025, 48% of survey respondents identified frequent changes to payers’ adjudication rules as a major factor impacting their organization’s ability to collect revenue. Close behind, 45% cited the volume and complexity of denials, while 43% pointed to unfavorable payer contract terms and reimbursement rates.
Looking ahead to 2026, the pressure only intensifies. 62% of respondents named denials and underpayment management as their top obstacle, followed by 46% citing reimbursement pressures and 44% naming staffing constraints.
As the Adonis report noted, “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.”
Denials Management: A Growing Strategic Priority
What was once dismissed as an operational nuisance is now a boardroom-level concern. More than one-third (36%) of RCM executives surveyed said the financial impact of claims denials is now discussed at the executive level of their organizations — a significant indicator of how central this issue has become to overall business strategy.
The operational burden is equally striking. Most RCM teams are spending between 51 and 75 hours per week managing denial-related work. That’s a substantial portion of staff time redirected away from proactive revenue improvement and toward reactive damage control.
This growing workload not only strains operational capacity but also signals an urgent need for smarter, more scalable approaches to denials management — approaches that go beyond manual review and legacy processes.
The Financial Impact of Denied Claims
The bottom-line consequences of payer-driven challenges are significant. Nearly half (47%) of survey respondents reported losing between 3% and 4% of net patient revenue as a direct result of denied claims, underpayments, or missed timely filing limits.
For healthcare organizations already operating on thin margins, a 3–4% revenue loss can be the difference between financial stability and crisis. As denial rates continue to climb and adjudication rules grow more complex, organizations that fail to adapt risk compounding these losses year over year.
Data Gaps and the Role of AI
One of the most pressing vulnerabilities identified in the survey is the lack of real-time payer performance data. 38% of respondents said that inadequate access to real-time payer data is a key factor limiting their revenue generation capabilities.
Without timely insight into payer behavior — including denial trends, adjudication rule changes, and underpayment patterns — RCM teams are essentially reacting to problems rather than preventing them.
This is where artificial intelligence is emerging as a critical tool. 29% of RCM leaders said that greater transparency and insight into payer activity is the most impactful outcome AI technology can deliver in the near term. From predictive denial analytics to automated underpayment detection, AI platforms are being positioned as essential infrastructure for the modern revenue cycle.
Looking Ahead: What RCM Leaders Must Do
The findings from this survey make one thing clear: the rules of revenue cycle management are changing. Payer complexity is no longer a background challenge — it is the defining obstacle for 2026 and beyond.
RCM leaders must prioritize investment in real-time data visibility, AI-powered analytics, and proactive denial prevention strategies. Organizations that continue to rely solely on internal optimization will find themselves at an increasing disadvantage in a landscape where payer behavior dictates financial outcomes.
Adapting to this new reality isn’t optional — it’s essential for long-term revenue health.
