Payer challenges remain the top stressor for revenue cycle leaders, according to an April 7 report from Guidehouse.
Guidehouse and the Healthcare Financial Management Association surveyed 191 provider executives in late 2025 about their challenges and investments in revenue cycle management. Fifty-two percent of those surveyed were hospital leaders, 39% were from health systems, and 9% were from medical groups.
Nearly every provider executive (88%) said that payer challenges were among their top three stressors, according to the report. That figure is up slightly from 86% in the previous survey.
Most leaders pointed to multiple shifts in payer behavior over the past year. Health system and hospital executives were most likely to report issues.
The payer behaviors observed by health systems include:
- Increase in denials: 81%
- Increase in prior authorization delays: 74%
- Increase in unclear or vague denial reasons or underpayments: 73%
- Excessive information requests: 69%
- Reduced reimbursement rates: 41%
According to the survey, the top five revenue cycle stressors are:
- Payer challenges: 88%
- Front-end and prior authorization attainment: 42%
- Impact of regulatory and legislative changes: 34%
- Workforce challenges: 33%
- Technology adoption and integration: 29%
Guidehouse noted that 25% of leaders surveyed said that cost to collect was a top stressor in 2025, while only 12% placed it among their top three stressors in 2026. Guidehouse said the shift may reflect the expansion of revenue cycle automation and self-service patient payment tools, “or simply a reprioritization of challenges.”
Read the full report here.
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