Revenue cycle performance is typically tracked through operational metrics such as denial rates, days in accounts receivable and cost to collect. In 2026, hospital and health system CEOs also discussed it as part of their broader strategy in turnaround plans, payer negotiations, earnings calls and 2027 budgets.
Some revenue cycle leaders say the function’s role is expanding this year. Amy Assenmacher, RN, senior vice president of revenue cycle at Grand Rapids, Mich.-based Corewell Health, said 2026 is “the ideal time for the revenue cycle to shine,” adding that revenue cycle will become “a key strategic capability.”
Health systems have reported pressure coming from several directions. Providence President and CEO Erik Wexler said in January that the Renton, Wash.-based system has seen “a 73% increase in payment denials and underpayments” from commercial payers. More than 15% of Cleveland Clinic’s claims are initially denied, and its CFO called the work required to appeal that rate down to below 2% “unsustainable.”
Revenue cycle leaders at 17 health systems said in September that payers are using AI to review claims at a scale most providers have not yet matched. Coverage losses add to the pressure: Premier projected hospitals will lose $68.6 billion in revenue during 2026-27 because of rising uninsurance tied to Medicaid and marketplace changes.
CEOs’ comments this year centered on three areas: operational fundamentals, payer relationships and who is best positioned to manage the work.
Revenue cycle as a fundamental
Some CEOs have described revenue cycle as one of the operational basics behind their financial performance.
St. Louis-based Ascension narrowed its operating loss by $371 million in fiscal 2026, closing out a three-year recovery. President and CEO Eduardo Conrado said in a June “Becker’s Healthcare Podcast” interview that the recovery came down to the basics.
“We looked at the operating model. How do we run efficiently? How do we drive out into a proper site of care? And then how do we manage a revenue cycle?” he said.
Ngozi Ezike, MD, president and CEO of Sinai Chicago, named the same lever in January, listing stronger revenue cycle management and cost control among her top priorities for the year ahead.
Denials and payer relationships
Other CEOs tied revenue cycle performance to how payers process and pay claims.
Mr. Wexler said in January that the system sees a denial rate in Medicare Advantage fee-for-service four times higher than in traditional Medicare, and requests for additional records 7.5 times higher. In June, he said Providence is owed more than $1 billion by commercial payers for Medicare Advantage patients. He has also said that payment performance will factor into Providence’s payer contracts.
“When it comes to UnitedHealthcare or any other commercial payer, if we are not seeing fair performance in how we are paid for the care we provide, and if denials and delays are not within a reasonable sphere of performance, then we are not going to continue working with that commercial payer,” Mr. Wexler said.
Franklin, Tenn.-based Community Health Systems CEO Kevin Hammons attributed part of a first-quarter volume decline to payers, saying they have “turned the dial up on denying preauthorizations in more cases.” Frank Corcoran, CEO of Lane Regional Medical Center in Zachary, La., has called for legislation to end denials issued after a service has already received prior authorization. He noted in June that “hospitals are left on the hook for denied claims” while appeals can take up to a year.
Who manages the work
CEOs have also made different decisions about whether to own revenue cycle operations or partner for them.
Providence sold its revenue cycle company, Acclara, to R1 RCM for $675 million in 2024. Mr. Wexler cited the move as part of the consolidation behind the system’s $400 million turnaround.
“We realized that we are not the best-known experts at revenue cycle, and combining forces with R1 allowed us to advance technological improvement in that space,” he said.
Other systems are increasing internal investment. At Dallas-based Tenet Healthcare, CEO Saum Sutaria, MD, said investment in its Conifer revenue cycle business will focus on automation, workflow reliability and AI.
“It’s reduction in the cost to collect stepwise over time, which makes the business more competitive from a pricing standpoint,” he said on an investor call. “And, secondly, improving the yield and the speed at which you realize that yield.”
King of Prussia, Pa.-based Universal Health Services CEO Marc Miller said during the system’s first-quarter earnings call that AI tools deployed across its revenue cycle are “yielding significant benefits, including improvements in denials management and revenue capture.”
Smaller hospitals are weighing the same choices as they plan for 2027. Summit Pacific Medical Center in Elma, Wash., plans to increase investment in revenue cycle systems and is exploring new CBO partnerships, CEO Josh Martin said in September.
“As HR 1 takes effect, Medicaid will lose enrollees, and insurance companies will fight harder to pay providers less going into 2027,” Mr. Martin said. “What determines whether a hospital is in the red or black next year all comes down to its payer strategy and revenue cycle optimization.”
