A recent article revealed some of the top priorities for revenue cycle leaders in 2026, and data from the MDaudit community supports the drivers behind these priorities.
Across executives interviewed, the dominant themes for 2026 include investing in robust technology platforms, applying automation and AI to core revenue cycle functions, strengthening leadership capacity, and using data-driven approaches to enhance efficiency and financial performance.
Let’s explore the top revenue cycle priorities for 2026 from today’s healthcare leaders.
1. Technology transformation is front and center
Several leaders said that implementing or optimizing key systems is a major focus. Health systems need technology that can span multiple facilities, specialties, electronic health records (EHRs), and functions of the revenue cycle.
What does this look like practically?
- Holistic Workflows
- Transparency
- Reimbursement Optimization
MDaudit’s 2025 Benchmark Report revealed top trends of 2025 supported by data from the MDaudit community (a robust nationwide footprint of 4,500+ facilities, 1.2M+ Providers, 140,000+ coders, and 5B+ in claim and remits used for benchmarking. Many of the report’s trends and insights support the above-
Request for information (RFI) and medical necessity-related to average denial dollars increased by 60% in the professional setting, 28% in the hospital outpatient setting, and 123% in the inpatient setting in 2025 relative to 2024.
The top payer types that drove the denial dollars were commercial insurance, with an incremental increase of 176%, and Medicare Advantage plans that increased 390% in this category this year.
Telehealth-related denials, where the service was provided at home, increased by 84% in 2025 compared to 2024. Telehealth-related denials where the service was provided other than in the patient’s home increased by 7% in 2025. The majority of these claims were denied due to missing information, errors in claim submission, non-covered charges, or duplicate claims.
At MDaudit, we believe the future of revenue integrity depends on moving from retrospective management to real-time intelligence. Organizations that invest in modern systems of intelligence, utilize AI and data to anticipate denials, automate workflows, and continuously measure coding and billing performance, are better equipped to weather payer behavior shifts, shrinking reimbursements, and optimize their financial health.
2. Automation and AI are widely seen as essential
Multiple respondents emphasized leveraging automation and artificial intelligence to reduce manual work, improve accuracy, and lower costs:
- Automating prior authorizations and denial prevention/appeals using predictive and AI tools.
- Building more efficient, scalable revenue cycle operations with minimal human intervention in routine tasks.
- Using automation across access, coding, billing, and collections to free up staff for more complex work.
Findings from the report show that the average denied amount across hospital inpatient and outpatient settings increased by double digits. That’s 14% in hospital outpatient and 12% in inpatient settings. Errors with diagnoses coding, modifier usage, and lack of support with medical records were the top three reasons that drove coding-related denials.
More than ever, revenue integrity teams are utilizing data and an AI-driven approach to unlock both risk mitigation and revenue optimization. Within the MDaudit platform, risk-based audits increased by 25% in 2025. Pre-bill audits increased by 30%.
3. Workforce strength and leadership matter
Many revenue cycle leaders shared that supporting their teams with automation and AI was a top priority. This is essential to managing costs and mitigating financial risks anticipated from Medicaid and ACA subsidy reductions.
Traditionally, the revenue cycle function has been hamstrung by manual processes, a lack of technology investments, and management support. Organizational leadership that transforms its functions does so with people, processes, technology, and analytic investments that drive exponential value to every stakeholder.
4. Precision and efficiency remain key
There’s a clear focus on improving revenue cycle efficiency through better technology, tighter workflows, and strategic use of automation to manage costs and mitigate risk from payer behavior and policy changes.
In 2025, the total at-risk amount from external payer audits increased by 30%. Automating workflows, task management, and employing eMDR and esMD capabilities will significantly improve response times to this scrutiny and help retain hard-earned revenues from clawbacks. By reducing reliance on manual processes, there’s a lower cost to collect, improved first-pass rates, and better support for teams along the revenue cycle.
Summary
Our priority for 2026? Is the redefining of revenue integrity. We’re helping organizations like yours shift from retrospective denial management to predictive, data-driven revenue optimization. Organizations that integrate AI responsibly and unite teams across multiple functions around real-time performance data will emerge more financially resilient in the year ahead.
Want to learn more about how we can support your revenue cycle priorities for 2026 and beyond? Contact us today.
