Healthcare revenue cycle leaders are sounding the alarm and they’re largely pointing in the same direction.
Across health systems large and small, from academic medical centers to community hospitals, a convergence of forces is reshaping the financial infrastructure of American healthcare: payers wielding AI and automation at unprecedented scale, denial rates climbing, prior authorization requirements multiplying, and administrative complexity outpacing the organizational capacity to manage it. Meanwhile, providers scrambling to keep up risk compounding the problem by deploying technology on top of broken processes.
The stakes extend well beyond balance sheets. When revenue cycle friction becomes a barrier between patients and care, when authorizations stall, bills confuse, and financial burden drives people away from treatment they need, the consequences are clinical, not just financial.
Becker’s asked revenue cycle leaders across the country to name the big challenges facing their organizations. Their answers reveal an industry at an inflection point, wrestling with questions about technology, governance, payer-provider dynamics, and what it means to keep patients at the center of a system under serious strain.
Ahmad Kilani, MD. Associate Medical Director, Revenue Cycle at Cleveland Clinic: The most dangerous trend in the healthcare revenue cycle is the shift away from a patient-centric approach. In principle, both payers and providers recognize that they share a relationship with the patient: providers deliver care, and payers cover the services that support that care, and patient’s name is in both: providers’ and payers’ own records. In an ideal system, providers and payers work together to ensure patients receive the best possible care without unnecessary waste. That is the essence of value in healthcare: the integration of quality and cost.
The danger arises when the patient is no longer the focus and the system becomes centered instead on revenue capture, denials, turnaround times, collections and accounts receivable. When the revenue cycle becomes purely a financial and administrative process, it drives higher costs year over year, especially when payers and providers fail to collaborate in identifying unnecessary expenses, administrative burden, and operational waste. This waste does not affect only payers and providers; it increases costs across the entire healthcare system.
Ultimately, the result is not only the abandonment of a patient-centric model, but also a second burden on the patient, who often ends up paying more, as time progresses, to receive the same care they still need.
Beth Carlson. Chief Revenue Officer of The Ohio State University Wexner Medical Center (Columbus): The most dangerous trend is revenue cycle friction becoming healthcare friction, as administrative and financial barriers increasingly stand between patients and the care they need. When patients abandon treatment because they can’t afford it, their authorization was delayed or denied, they couldn’t navigate the process, or the administrative burden simply became too great, the consequences of care that never happens may be the most important denial we’re not measuring.
Tami McMasters Gomez. Executive Director of Mid-Revenue Cycle at UC Davis (Sacramento): If I had to identify one trend that poses the greatest risk to healthcare revenue cycle organizations over the next three to five years, it would be the rapid escalation of payer-driven automation combined with increasing denial complexity.
Payers are leveraging automation to review 100% of claims while most health systems still manually review only a small fraction of payer activity.
That creates an imbalance that providers can only overcome through their own use of AI, predictive analytics, stronger documentation practices, and tighter integration between CDI, coding, revenue integrity, UM, and denials management.
In short: the greatest threat is not autonomous coding replacing staff. It is payer automation denying or delaying reimbursement faster than providers can identify and respond to it.
Tanya Sanderson, RN. Senior Director – Denials Management at Stanford Health Care (Palo Alto, Calif.): The most concerning trend I see is the growing imbalance between the administrative demands placed on providers and the resources available to manage them. While technology and automation are creating important efficiencies across healthcare, they are also contributing to increased complexity in areas such as authorizations, denials, reimbursement and payment integrity. For revenue cycle leaders, this creates increasing challenges in accurately measuring reimbursement performance and identifying lost revenue hidden within denials, underpayments, and payment leakage. As administrative burden continues to grow, it threatens not only financial sustainability, but also workforce resilience and access to care in the communities that depend on it.
Jody Hinton. Vice President of Medical Operations at PDS Health (Irving, Texas): The most dangerous trend in the healthcare revenue cycle is the growing arms race between payers and providers, and right now, the payers are winning.
Payers are increasingly using AI, advanced analytics, and automation to identify reasons not to pay claims, often at a scale and speed providers can’t match. At the same time, many healthcare organizations are still relying on manual processes and reacting to denials after they occur instead of preventing them in the first place.
The answer isn’t building bigger denial teams. It’s leveraging the same technologies, including AI, automation, and predictive analytics, to identify risks before claims are submitted and eliminate preventable denials before they ever happen.
The organizations that thrive over the next five years will be the ones that stop treating revenue cycle as a back-office collections function and start treating it as a strategic capability that directly impacts growth, profitability, and the patient experience.
Dawson Ballard Jr. Coding Auditor and Educator, Rush University Medical Center (Chicago): I think the most dangerous trend in health IT is the rapid adoption of AI without adequate governance, oversight, and cybersecurity safeguards. While AI can improve efficiency, it also creates risks related to inaccurate outputs, bias, and overreliance on automation.
From a provider education and revenue cycle perspective, AI-assisted documentation and coding tools are particularly concerning because errors can create compliance, reimbursement, and audit risks if they’re not carefully reviewed by a human.
Ransomware remains a major threat, but poorly governed AI has the potential to have an even broader impact on patient safety, compliance, and financial performance.
Austin Palmer, MHA, CHFP, Director, Business Analytics & Data Science, AdventHealth (Altamonte Springs, Fla.): In my view, the most dangerous trend in healthcare revenue cycle today is the increasing unpredictability of reimbursement models. Healthcare organizations are being challenged by a growing mix of payer policy changes, evolving value-based care arrangements, prior authorization requirements, shifting government reimbursement methodologies, and increased scrutiny of claims. As a result, reimbursement is becoming more difficult to forecast and manage with confidence, creating significant financial risk. Health systems must make strategic investments in staffing, technology, and patient access without a clear understanding of how reimbursement rules may evolve or how payer behavior may change.
Lindsay Bennett. Chief Revenue Officer at Centerstone (Nashville, Tenn.): The most dangerous trend in the healthcare revenue cycle is fragmentation, where departments are solving individual problems without clear ownership of the end-to-end financial impact or patient experience. That fragmentation leads to loss of access and revenue, compliance risk, and avoidable technology spending. Here are three examples:
- Medicaid cuts: The eligibility and coverage changes beginning January 1, 2027, are not simply an eligibility issue for revenue cycle. Centerstone has brought together stakeholders from across the organization, recognizing that protecting patient access and revenue will require data and analytics, patient outreach, state-specific coordination, and staff education.
- Compliance: Clinicians document care that ultimately populates a claim they likely never see, while Revenue Cycle sees the claim but not the patient encounter. Strong collaboration between Clinical Operations, Compliance, IT, and Revenue Cycle is critical to closing that gap in an era of increasing automation and enforcement.
- AI and automation: Overspending on technology investments can occur when each department purchases isolated solutions for its own pain points without a more integrated view. For example, a well-designed front-end intervention may eliminate the need for multiple back-end tools.
Shelly Thompson, MSN, RN, Senior Director of Clinical Revenue Cycle and Revenue Integrity, Sentara Health (Norfolk, Va.): One of the trends that concerns me most is how quickly AI is being adopted across the healthcare revenue cycle, both by payers and providers.
On the payer side, we’re seeing AI used more frequently for prior authorizations, medical necessity reviews, denials, and post-pay audits. The area that concerns me the most is AI-driven DRG downgrades and post-payment audits. Payers can now review massive volumes of claims and identify opportunities to challenge reimbursement much faster and on a much larger scale than ever before.
At the same time, healthcare organizations are integrating AI into the EMR to support documentation and improve efficiency. While the potential benefits are significant, there is also risk if AI-generated documentation is not carefully reviewed or does not accurately capture the patient’s clinical story. As payer AI becomes more advanced, any gaps, inconsistencies, or weaknesses in the medical record can become targets for audit activity.
To me, this makes documentation integrity, coding accuracy, physician engagement, and audit readiness more important than ever. It’s no longer enough to focus on getting claims paid. We also have to be prepared to defend the care that was provided and the reimbursement that was earned long after the claim has been processed.
Miguel “Mike” Vigo IV. Chief Revenue Officer of UC San Diego Health: The greatest trending threat to healthcare revenue cycle that I see is not a technology problem or a workforce problem. It is the accelerating mismatch between what payers require and what providers can realistically sustain. When administrative burden and complexity outpaces operational capacity, we see margins erode, clinicians become burdened with negative impact to their wellness and can directly impact patient experience and timely access to care. Our aim and approach should be focused on ensuring providers and effective healthcare organizations can simplify, automate, and redesign revenue cycle processes before complexity overwhelms the system and the teams.
Karen Brown. Director of Revenue Cycle at Heart of the Rockies Regional Medical Center (Salida, Colo.): One of the most dangerous trends in healthcare revenue cycle is the increasing complexity of insurance reimbursement combined with evolving regulatory requirements. Frequent changes in payer policies, prior authorization requirements, coding guidelines, and government regulations make it increasingly difficult for healthcare organizations to receive timely and accurate reimbursement.
At the same time, rising patient financial responsibility has created additional challenges in collecting payments while maintaining a positive patient experience. As deductibles and out-of-pocket costs continue to increase, organizations must balance financial stewardship with compassion and transparency.
Another significant concern is the rapid implementation of new technology, including electronic health records and automation. While these tools improve efficiency, they also require strong workflows, staff training, and data integrity. Poor implementation or inaccurate data can lead to claim denials, delayed reimbursement, compliance risks and lost revenue.
To remain successful, healthcare organizations must focus on proactive denial prevention, accurate patient registration, financial transparency, continuous staff education, and cross-department collaboration. Building strong processes before claims are submitted is far more effective than correcting issues after the fact. Organizations that embrace change while maintaining a patient-centered approach will be best positioned to navigate the evolving healthcare landscape.
Christopher Smith. CFO at UT Le Bonheur Children’s Hospital (Memphis, Tenn.): The most dangerous trend in healthcare revenue cycle is the normalization of administrative friction. We have come to accept denials, authorization requirements, data gaps, manual workarounds, and delayed payment as simply part of doing business.
Technology and AI can absolutely help, but there is also a risk that we simply automate around broken processes rather than fixing them. If we make inefficient processes faster without addressing the underlying issues in data flow, payer-provider interaction, and workflow design, we have not really solved the problem. The organizations that will be successful are the ones that use technology to remove friction, not just manage it more efficiently.
Shannon Cameron. COO, Revenue Cycle and AFS of Harvard Medical Faculty Physicians (Boston): I think one of the most dangerous trends in revenue cycle right now is that healthcare is becoming more complicated faster than organizations can keep up with it. Payer rules are changing constantly, denials are becoming more sophisticated, reimbursement is getting tighter, and we are adding AI and automation into the mix at an incredible pace.
Technology can absolutely help us, but it can also create a false sense of security. If the underlying process is broken, automating it just means you can make the same mistake much faster and across thousands of claims instead of a handful.
For me, the bigger issue is visibility. Too many organizations still discover revenue problems after the money has already been lost. We have shifted the focus on using our data to recognize changes in payer behavior, documentation and coding gaps, denial patterns, and other revenue leakage early enough to actually do something about it. This is another area we have shifted from reactive to proactive using predictive technology.
Kathleen Moriarty, MSN, RN. Senior Director of Case Management at Ann & Robert H. Lurie Children’s Hospital of Chicago: The greatest risk is the growing gap between increasing payer complexity and the resources hospitals have to manage it. Expanding prior authorizations, automated denials, and complex reimbursement rules create financial strain, delay care, and increase clinician and workforce burden.
A strong case management team helps bridge the gap between clinical care and reimbursement, enhancing the patient experience through effective clinical-financial collaboration and navigation of healthcare complexities.
Kendra Langmade. Director of Operations and Finance for Perioperative Services at M Health Fairview (Minneapolis): From a surgical services perspective, payer denials are one of the greatest financial risks we face. A case can be clinically appropriate, successfully performed, and documented, but if there is an authorization issue, registration error, or payer denial that cannot be overturned, the organization may never be reimbursed for the care delivered. That makes front-end accuracy and revenue cycle integrity more important than ever.
Balaji Raman. Epic Director of Revenue Cycle and Access at WMC Health (Valhalla, N.Y.): For me, the most dangerous trend is moving too quickly with AI without the right governance in place. There is a lot of pressure to adopt the newest technology, but not every solution will add meaningful value or fit within an organization’s existing environment. I would first look at the capabilities offered by the EHR vendor and other trusted partners that already understand the organization’s workflows and data. Regardless of the vendor, every solution still needs to be evaluated for accuracy, security, compliance, integration, and measurable value before it is introduced into the revenue cycle.
Aaron Klein. Senior Vice President of Financial Operations and Supply Chain at Carle Health (Urbana, Ill.): I believe the most significant risk in healthcare revenue cycle today is the broader shift toward increasingly aggressive payer adoption of denials combined with payers’ adoption of silently reducing payment. The newer, and potentially more concerning development is payer downcoding and reimbursement reduction without formal denial activity leading to decreased yield and net revenue erosion. These payment reductions often do not appear in traditional denial reports making revenue leakage difficult to identify. A good example of this is recent adoption of a national Medicare Advantage plan “low severity” payment downgrades for inpatient cases. We’ve experienced a significant volume of payment downgrades for inpatient stays far exceeding two midnights. The adoption of these practices not only erode revenue for justifiable acute inpatient care, but they create a significant administrative burden on health systems as they fight for appropriate payment for the care they provide.
Rebecca Ashe. Director of Finance Education and Quality Assurance at Moffitt Cancer Center (Tampa, Fla.): A dangerous trend we are seeing across healthcare is the growing gap between the care delivered and the administrative effort required to secure payment. Increasing payer complexity, prior authorization requirements, and denial activity consume significant resources within health systems. To address these challenges, organizations are leveraging a combination of people, strategic partnerships, technology, and emerging AI capabilities to maximize efficiency and support a sustainable workforce. Those that cannot effectively manage this growing friction will continue to face mounting pressure on both financial performance and employee well-being.
Angela Mauch. Senior Director of Clinical Revenue Cycle at The University of Kansas Health System (Kansas City): We’ve experienced a sharp increase in denials and audits over the past several years. As payer requirements and policies become more fragmented and complex, administrative demands continue to drive payment delays and revenue shortfalls, forcing revenue cycle leaders to constantly adapt. Most concerning is that while AI and automation are advancing rapidly, many payers continue to introduce policies they cannot consistently enforce through their own systems. As a result, hospitals and providers must build and maintain increasingly complex rules within their EMRs and billing platforms to ensure compliance and submit clean claims.
Jill Gunn. Chief Revenue Officer at Legent Health (Plano, Texas): The most dangerous trend in healthcare revenue cycle is the rush to buy AI without building the operational infrastructure to make it work. Every RCM vendor is slapping “AI-powered” on their product, and health systems are writing checks for tools that sit on top of broken workflows. AI doesn’t fix bad data, inconsistent coding, or a team that doesn’t understand payer-specific rules. It amplifies whatever is underneath it. At Legent, we built our AI platform from the inside out, starting with the workflows, the payer logic, and the clinical context, then layering intelligence on top. The organizations getting real value from AI in RCM are the ones doing the hard, unglamorous work of cleaning up their operations first. If your denial rate is high because your front-end processes are broken, no AI tool is going to save you. The technology is powerful, but only if it’s built on a foundation that actually works.
Stacie Zins. IT Director, Clinical and Revenue Cycle Applications at North Memorial (Robbinsdale, Minn.): One of the most dangerous trends in healthcare revenue cycle is the accelerating use of automation and AI by payers to drive increasingly complex denial and prior authorization processes. While these technologies can improve efficiency, they often shift administrative burden onto health systems, requiring significant resources to identify, appeal, and resolve denied claims. This creates a widening technology gap, where providers must continually invest in new tools and workflows simply to keep pace. In an environment already challenged by thin operating margins and workforce constraints, this arms race between payer and provider technologies is becoming increasingly unsustainable and poses a significant risk to the financial health of healthcare organizations.
Ankit Rohatgi, MD. Vice President, Physician Advisory and Utilization Management at UC Health (Cincinnati): Today’s revenue cycle challenges are driven by increasing payer complexity, rising denial rates, cumbersome prior authorization requirements and ongoing reimbursement delays. Healthcare organizations must navigate growing documentation expectations while balancing staffing constraints and mounting operational pressures.
At the same time, workforce shortages and escalating administrative demands are contributing to staff burnout, as revenue cycle teams are expected to manage higher workloads with limited resources. This creates challenges in maintaining efficiency and increases operational fatigue.
Adding to these challenges, greater patient financial responsibility has made collections more difficult and has increased financial risk.
To remain financially stable while supporting their workforce, organizations are investing in process improvements, better documentation practices, and technology-driven solutions that enhance efficiency and optimize revenue capture.
