From the denials to critical updates on 340B and prior authorization, here is a look back at the trends and tactics that defined the revenue cycle in 2025.
If there is one theme that defined 2025 for revenue cycle leaders, it is friction.
From aggressive payer policies and relentless claim denials to insufficient reimbursement updates and regulatory curveballs, this year tested the resilience of provider financial operations.
Of course, it isn’t all bad news. The year also saw leaders fighting back with innovative patient-centric strategies, digital transformation, and success in value-based care models.
As we close the book on another year, here are the top 10 stories that captured the attention of revenue cycle executives in 2025.
1. Cigna Intends to Unilaterally Downcode E/M Claims
Over the summer, Cigna announced a decision to unilaterally downcode Evaluation and Management (E/M) claims, sparking outrage among revenue cycle leaders. This story took the top spot because it strikes at the heart of a fundamental revenue cycle struggle: getting paid appropriately for the level of care actually delivered.
2. No Denying There’s a Claim Denial Problem
Denials were a sticky issue for revenue cycle leaders in 2025. This story on surging denial rates across the industry resonated widely, validating what many revenue cycle leaders experience on a regular basis. Payers are saying "no" more often, and the administrative cost to overturn those decisions is rising.
3. How a Crisis Spurred a Patient-Centric Rev Cycle Strategy at OhioHealth
This profile on OhioHealth was a standout, detailing how the health system leveraged a crisis to reinvent its revenue cycle around the patient. It served as a powerful reminder that operational efficiency and empathy are not mutually exclusive.
4. Winning Edge: Tackling the Denials Dilemma
Revenue cycle leaders are eager for actionable strategies to combat the denial surge. From leveraging AI for predictive appeals to restructuring teams for better CDI, this piece provides a playbook for revenue cycle leaders looking to protect their margins.
5. Executive Order Puts 340B Drug Pricing Back in Spotlight
The 340B program is a critical lifeline for safety-net providers, and it is rarely far from the headlines. When the White House issued an Executive Order targeting drug pricing reforms earlier this year, revenue cycle leaders paid close attention to its potential implications.
6. CMS to Test New Prior Authorization Requirements for Traditional Medicare
Prior authorization is a primary source of burnout and delay. When CMS announced it would pilot new requirements for traditional Medicare, it signaled a potential shift in the regulatory landscape. RCM leaders read this story to stay ahead of the curve, understanding that where CMS leads, private payers often follow.
7. Provider Advocacy Group Blasts ‘Highly Problematic’ Aetna Payment Policy
Another chapter in the payer abrasion saga. When advocacy groups publicly condemned Aetna’s payment policy changes, it rallied providers who were feeling the squeeze. This story highlighted the importance of collective voice and industry pushback in checking aggressive payer tactics.
8. Let’s Get Digital: How 2 RCM Leaders Are Tapping Tech to Improve Patient Access
Health systems have rolled out the welcome mat at the digital front door. This look at how two different leaders implemented technology to smooth out patient access offered a practical roadmap for reducing friction at the very start of the revenue cycle.
9. Here’s Why Hospital Leaders Hate the Proposed IPPS Rate Increase
Inflationary pressures made the proposed 2026 Inpatient Prospective Payment System (IPPS) look particularly painful. This story aimed to help revenue cycle leaders understand the gap between the proposed rate hikes and the skyrocketing costs of labor and supplies.
10. Bundled Payment Program Yields Big Savings for Commercially Insured Patients
Rounding out our top 10 is a success story in value-based care. Although it was published in 2021, the topic still resonates with revenue cycle leaders.
While fee-for-service remains dominant, this article on bundled payments demonstrated that alternative payment models can deliver real savings for commercially insured populations, proving that value-based arrangements are viable beyond the Medicare space.
Luke Gale is the revenue cycle editor for HealthLeaders.