From a revenue cycle perspective, 2025 threw us some curve balls.
For the first time in six years, the Centers for Medicare and Medicaid Services proposed an increase to the Physician Fee Schedule. At the same time, they also suggested substantive changes to practice expense methodology and proposed an efficiency adjustment that will offset the gains for many facility-based physicians.1
Additionally, new research from the American Medical Association showed that physician usage of AI technology jumped 80% in just one year.2 In a few short months, AI (augmented intelligence, per AMA’s preferred parlance) was elevated from intriguing newcomer to disruptive force, demanding its own well-thought-out strategy for adoption and implementation.3
As we look ahead to 2026, regulatory uncertainty and disruptive change will continue to influence revenue cycle management (RCM) and impact physician reimbursement. From unpredictable payer behavior to compliance hurdles, medical practices will encounter new versions of the same challenges that have been sapping revenue for the last several years.
Specifically, the following issues and influences are the ones to watch for in 2026. Effective practices can begin preparing now, leveraging advanced analytics, tracking performance benchmarks, and enlisting the right partners to develop a plan for practice optimization. Here’s what you need to know.
Viability of Independent Practices
Independent practices are especially affected by the combination of influences on revenue across healthcare. Rising operational costs, steadily declining reimbursement, and forced consolidation are all making it exceedingly difficult for independent groups to remain financially sustainable.
Independence is still possible despite the challenges, but practices will need to find strength through economies of scale. Without the advantage of scale, small groups will struggle to stay competitive on key operational fronts:
- Recruiting—Provider shortages are hobbling specialties including anesthesia4 and radiology5, making it more competitive and expensive to attract and retain new physicians. It will be difficult in this environment for small groups to prevail against hospitals and larger groups.
- Payer Contracting and Reimbursement—Without leverage to negotiate more favorable terms with payers, small groups may be squeezed even harder by bad payer behavior,6 such as increasing denial rates, frequent down-coding, unexpected (and often unpublicized) compliance changes, and other reimbursement reducers.
- Technological Advancement—Medical group viability will depend on leveraging technologies such as analytics dashboards, AI ambient notetakers, and RCM automation. Small groups may struggle to keep up, finding these tools too expensive to implement and maintain in a meaningful way.
WHAT TO DO NOW
Plan for growth. Independent groups should focus this year on increasing their leverage and negotiating power. Mergers and organic expansion are not the only options for growth. Strategic RCM partnerships can also effectively deliver economies of scale, unlocking access to powerful data & analytics, expert contract negotiation, and optimized coding and billing for higher reimbursement. According to a recent benchmarking survey from the American Medical Association7, the top reasons private practices were sold between 2012 and 2024 included: better leverage to negotiate payment terms with payers; better access to costly resources; administrative support to handle payer requirements; and ability to compete for top employees. Independent groups can achieve these goals with a strong strategic RCM partner.
Price Transparency and Payer Contracting
While the No Surprises Act (NSA)8 was intended to limit patients’ responsibility for out-of-network services, it also inadvertently made it easier for health plans to keep providers out of network. This effectively shifted more of the payment burden to providers.
On the other hand, the NSA also included provisions that are beneficial to providers. Price transparency rules enacted alongside the NSA in 2022 gave us access to critical benchmarking data that show what health plans are paying to hospitals and providers across the country. The NSA also established the Independent Dispute Resolution (IDR) process,9 which allows providers to appeal denials and underpayments specific to out-of-network cases. As a third-party arbitration process, IDR establishes a forum for providers and payers to negotiate on individual claims in a way that removes the patient from the debate.
Few providers fully understand how to leverage NSA data or the IDR process to their advantage. Benchmarking data now confirms whether the rates offered to you by a health plan are, in fact, competitive for your market. This game-changing knowledge can be used strategically to negotiate better contracts and reimbursement terms with payers.
As for IDR, although the vast majority of IDR appeals are resolved in favor of the provider, it remains underutilized. In the first half of 2023, CMS data showed that only 10% of eligible claims went through arbitration—even though health plans underpaid their providers in 100% of cases.10 In addition to revenue recovery, IDR results can also be catalysts to bring payers to the negotiating table and secure favorable in-network contracts.
WHAT TO DO NOW
Take advantage of the IDR opportunity. While providers have prevailed in IDR appeals for the last few years, it’s only a matter of time before payers find a way to regain the upper hand. Recovery of this cash is also a lengthy process; therefore it makes sense to start as soon as possible. A strategic partner that specializes in IDR appeals can leverage technology and expertise to help you secure reimbursement and strengthen your payer relationships.
Patient Payments
By some estimates, patient payments may represent as much as a third of physician revenue. Collecting those payments will likely demand more effort and attention in 2026 as economic uncertainty intensifies for patients.
Newly released data from the health research group KFF found that premiums for employer-sponsored health plans rose sharply in 2025, and they’re expected to rise again in 2026.11 Patients are concerned. Nearly 40% already struggle to pay their monthly premiums and more than 60% are worried they won’t be able to afford out-of-pocket costs for health care services or unexpected medical bills.12
Providers will need to be strategic this year about self-pay collections, particularly in specialties such as radiology where patients may have many options when seeking care.
WHAT TO DO NOW
Prioritize patient experience. Studies show that transparency and frictionless patient processes can improve patient-pay revenue. For example, 32% of people pay their bills within five minutes of receiving it via text.13 Conversely, 36% said they would consider switching healthcare providers if they have a poor experience with billing.14 In a climate where one bad Google review can significantly impact revenue, your RCM partner or in-house team should include self-pay specialists. Ensure they focus on the entire payment journey, from accurate up-front price estimates to intuitive digital payment options.
AI and Automation in Healthcare
The excitement around AI will intensify in 2026 as providers and hospitals begin to embrace the possibilities. AI is being used across specialties for everything from ambient note capture and documentation support on the administrative end, to real-time risk analysis and diagnosis assistance on the clinical side. AI’s potential efficiencies become even more critical in the context of practice viability, as providers struggle to see more patients during an ED shift, manage skyrocketing numbers of radiology imaging studies, and keep up with increasingly burdensome administrative tasks.
However, much remains to be seen about AI’s safety and efficacy for patient care, including questions surrounding patient privacy, the accuracy of AI transcription, and the need for physician oversight on AI tools. Providers are also understandably worried as payers leverage AI to automate claim denials and lower physician payments.
While this plays out, we see huge opportunity this year to use AI and automation in RCM to stay a step ahead of the payers. Advanced analytics and automation can correct claim errors before they lead to denials, flag payer trends that could impact revenue, and ultimately shorten the revenue cycle and improve cash flow.
WHAT TO DO NOW
Develop a strategic AI plan. AI is best viewed as a strategic initiative,15 not a one-off technology purchase. Practices have many questions to answer before they can determine AI’s true ROI at the practice level: Who will use the technology? How will patients adapt to it? Will the technology create more work downstream that will offset the efficiencies it delivered? AI will undoubtedly be part of your practice’s future. Preparing for it now, in a thoughtful way, will ensure your team selects tools that will live up to their potential.
How Ventra Can Help
The issues and influences heading our way in 2026 will require medical groups to take a strategic approach to practice optimization. Each of the 2026 trends will force us to find ways to work more efficiently, use data proactively, collect payments faster, and improve relationships with payers and facilities.
At Ventra Health, we’ve made it our mission to assemble the technology and expertise to help facility-based physician groups thrive under even the strongest industry headwinds.
- Leveraging vSightTM, our powerful data & analytics platform, we use data end to end across the revenue cycle, uncovering ways to submit claims faster, reduce denials, and shorten days in AR. Our Performance Surveillance Team, staffed by our data scientists, monitors client metrics 24/7 to spot issues—like a spike in denial rates—and correct them before they can impact revenue.
- Our dedicated self-pay teams deliver outstanding service and a frictionless patient experience to facilitate patient payments.
- We have the size, strength, and longstanding payer and facility relationships to give providers a seat at the table in contract negotiations. We use industry benchmarking data and practice data to build a well-documented case to negotiate reasonable in-network terms.
- We offer leading IDR support, combining innovative technology, proprietary data insights, and unique tactics to secure timely reimbursement.
- Our leaders are industry advocates, fighting for reforms on Capitol Hill that will improve reimbursement for all facility-based physicians. Many of us are nationally recognized leaders in organizations including the American College of Emergency Physicians (ACEP), the American Society of Anesthesiologists (ASA), the Radiology Business Management Association (RBMA), and more.
From contract negotiation to data analysis to long-range planning, strategic support will be critical this year. Resources are available to help your practice stay competitive and sustainable. As we head into 2026, start now to align your team.
Resources
1 “First Look at the CMS 2026 Physician Fee Schedule Proposed Rule,” Ventra Health, July 24, 2025, accessed October 24, 2025, at https://ventrahealth.com/blog/cms-2026-physician-fee-schedule-proposed-rule/
2 “2 in 3 physicians are using health AI—up 78% from 2023,” American Medical Association, February 26, 2025, accessed October 24, 2025, at https://www.ama-assn.org/practice-management/digital-health/2-3-physicians-are-using-health-ai-78-2023.
3 “Navigating AI Adoption in Medical Practices,” Ventra Health, August 6, 2025, accessed October 24, 2025, at https://ventrahealth.com/article/navigating-ai-adoption-in-medical-practices-gated/
4 “Anesthesiologist shortage in the United States: A call for action,” Journal of Medicine, Surgery, and Public Health, April 2024, accessed October 24, 2025 at https://www.sciencedirect.com/science/article/pii/S2949916X2400001X?via%3Dihub
5 “The radiologist shortage, explained,” Becker’s Hospital Review, December 31, 2024, accessed October 24, 2025, at https://www.beckershospitalreview.com/radiology/the-radiologist-shortage-explained.html
6 “4 Bad Payer Behaviors that are Impacting Reimbursement for Facility-Based Physician Groups,” Beckers Hospital Review, Jan. 31, 2025, accessed October 24, 2025, at https://www.beckershospitalreview.com/hospital-management-administration/4-bad-payer-behaviors-that-are-impacting-reimbursement-for-facility-based-physician-groups/
7 “Physician Practice Benchmark Survey,” American Medical Association, updated September 25, 2025, accessed October 24, 2025, at https://www.ama-assn.org/about/ama-research/physician-practice-benchmark-survey
8 “No Surprises: Understand your rights against surprise medical bills,” Centers for Medicare & Medicaid Services, CMS.gov, accessed October 24 2025, at https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills
9 “Turning the Tables: How Providers Can Regain Leverage Through the IDR Process,” Ventra Health, July 7, 2025, accessed October 24, 2025, at https://ventrahealth.com/white-papers/turning-the-tables-how-providers-can-regain-leverage-through-the-idr-process/
10 “ACEP First Look: CMS Data on Federal IDR Process Under the No Surprises Act,” American College of Emergency Physicians, February 16, 2024, accessed May 21, 2025, at https://www.acep.org/news/acep-newsroom-articles/acep-first-look-cms-data-on-federal-idr-process-under-the-no-surprises-act
11 “Workers and Employers Face Higher Health Insurance Costs,” The New York Times, October 22, 2025, accessed October 24, 2025, at https://www.nytimes.com/2025/10/22/health/health-insurance-costs-2025.html
12 “Americans’ Challenges with Health Care Costs,” KFF, July 11, 2025, accessed October 24, 2025, at https://www.kff.org/health-costs/americans-challenges-with-health-care-costs/
13 “32% of people will pay their medical bill within 5 minutes of getting a text about it,” HealthLeaders, October 15, 2021, accessed October 24, 2025,, at https://www.healthleadersmedia.com/revenue-cycle/32-people-will-pay-their-medical-bill-within-5-minutes-getting-text-about-it
14 “Billing and texting: More patients want digital reminders,” Chief Healthcare Executive, May 30, 2023, accessed October 24, 2025, at https://www.chiefhealthcareexecutive.com/view/billing-and-texting-more-patients-want-digital-reminders
15 “Navigating AI Adoption in Medical Practices,” Ventra Health, August 6, 2025, accessed October 24, 2025, at https://ventrahealth.com/article/navigating-ai-adoption-in-medical-practices-gated/
