Revenue cycle management (RCM) leaders see the reimbursement environment as the biggest challenge to their growth ambitions, according to a new survey.
Analysts at RCM company Adonis polled more than 120 leaders in this space across 18 specialties. They found that payer behaviors have jumped over internal challenges like staffing as the largest risk to revenue growth. In previous years, internal improvements were most likely to be cited.
About half (48%) of those surveyed said frequent changes made to payers' adjudication rules was a major factor impacting their organization's ability to collect revenue in 2025. Forty-five percent cited the volume and complexity of denials, and 43% said payer contract terms and reimbursement.
For 2026, 62% cited denials and managing underpayments as a top obstacle. About half (46%) said reimbursement pressures, while 44% named staffing constraints.
"This shift marks a departure from prior years, where internal optimization was viewed as the primary lever for improvement," per the study. "In 2026, revenue performance is increasingly dictated by payer behavior rather than patient volume or internal capacity."
The report found RCM executives increasingly view claims denials and management as a major financial and strategic challenge rather than an "operational nuisance." More than a third (36%) said the impact of denials is an issue discussed at the "executive level" of their organizations.
The survey respondents also said managing claims denials is accounting for an increasing amount of operational time. Most said RCM teams are spending between 51 and 75 hours each week managing work related to denials.
About half of those surveyed (47%) said they lost between 3% and 4% in net patient revenue as a result of denied claims, underpayments or timely filing limits.
As they look to manage these challenges, the RCM leaders said their organizations lack data and insight into payer behaviors and their greatest risks. Thirty-eight percent of those surveyed said their lack of real-time access to data on payer performance is a key factor impacting revenue generation.
They're looking to artificial intelligence and other technology platforms to assist as they navigate the data gaps. Twenty-nine percent of the RCM leaders surveyed said they believe greater insight and transparency into payer activity is the "most impactful outcome" AI tech can improve this year.