Eligibility churn and redetermination pressure remain significant for revenue cycle teams, but they’re no longer the whole story. Heading into 2027, new Medicaid community engagement and six-month renewal requirements will add eligibility complexity for affected populations, while Medicare payment updates and proposed outpatient policy changes continue to shift hospital economics.
At the same time, scrutiny of pricing, enrollment, documentation and payment accuracy is raising broader questions about where revenue integrity begins and ends, who owns it, and which capabilities deserve investment. In this session, healthcare finance and revenue cycle leaders will discuss where exposure is concentrating, how regulatory change becomes operational change and what separates a resilient revenue integrity function from a reactive one.
Learning points:
- Identify where revenue exposure is concentrating as revenue integrity expands beyond coverage
- Describe how regulatory and payer changes become operational changes, including realistic implementation timelines
- Examine how increased scrutiny is reshaping ownership across compliance, coding, CDI and revenue cycle
- Recognize what distinguishes resilient revenue integrity functions from reactive ones