From the possible rise of agentic AI to the potential for payer cooperation on prior authorization, we look at five questions revenue cycle leaders will face in 2026.
As 2026 begins, healthcare revenue cycle leaders are contending with a frustrating mix of adversarial payer practices and significant policy changes at the federal level.
With hospital margins remaining thin, success in the year ahead will depend on how effectively executives respond to trends impacting the revenue cycle.
Will Denials Continue to Rise?
Denials plagued revenue cycle leaders in 2025. More than 40% of providers reported denial rates exceeding 10%, a figure that has risen steadily since at least 2022. Payer adoption of AI has likely driven denial rates higher.
However, the issue with denials extends beyond quantity.
“We are seeing more – not only in volume, but in ambiguity and variety and complexity,” Beth Carlson, VP Revenue Cycle at WVU Health, told HealthLeaders last year.
Health systems have typically taken a reactionary approach to denial management, but more are turning to a preventative strategy, engaging with clinical, legal, and IT teams to stem the flow.
Will Agentic AI Make an Impact?
Health systems have deployed generative AI with successful results so far. Moving forward, will the focus shift to agentic AI?
Autonomous digital agents are now capable of executing certain tasks, like logging into payer portals to upload medical documentation, without human intervention. If agentic AI technology progresses to a point where it can reliably complete mundane, repetitive tasks, it could help to alleviate staffing shortages and allow human staff to focus on more complex work.
Will Policy Changes Accelerate Changes in the Front End?
While healthcare lags behind other industries in the digital space, many health systems have made significant efforts to improve their patient-facing technology offerings.
Moving forward, policy changes will likely force more health systems to focus on the front end. Patients are taking on a greater burden for their healthcare costs, which increases urgency around point-of-service and pre-service payments. Medicaid cuts and changes to the Affordable Care Act will cause millions to lose their health coverage, putting even more pressure on patient access teams and billing departments.
Will Health Systems Pull Back on Tech Investments?
As the hype surrounding AI and other emerging technologies wcontinues, health systems are likely to consider investments more cautiously. Facing a market with an abundance of vendors, providers can now ask for more from their partnerships. Five-year contracts are no longer the norm, as revenue cycle leaders look for short-term contracts with multiple exit ramps if technologies don’t deliver.
Can Providers and Payers Find a Way Forward on Prior Auth?
Payers and providers have been locked in an adversarial relationship for years. Prior authorization is a particular point of contention, and friction over the utilization management tool reached a breaking point in 2025. A coalition of more than 40 payers announced that they would voluntarily reform PA processes to reduce administrative burden on both sides. Their commitment aligns with mandates in the CMS Interoperability and Prior Authorization Final Rule that should implement new standards for data transmission.
Luke Gale is the revenue cycle editor for HealthLeaders.