Payer policy changes that never reached the contract were the top revenue leakage risk, picked by 68.0% of 100 respondents in HFMA's May 2026 survey. Inconsistent payment practices across payers came second at 64.0%.
HFMA ran the survey with sponsorship from Trek Health and published the analysis on August 17, 2026. The respondents were mostly finance and revenue cycle leaders at large organizations, so the numbers describe contract risk at scale. They still map to what a practice manager sees on remittances.
Who answered the HFMA survey
HFMA sent the survey to 5,571 people through Qualtrics and received 161 responses, a 3.0% response rate. Most questions had fewer answers. The revenue leakage question had a base of 100, and the organization type question had a base of 134.
Among the 134 who gave an organization type, 72.0% worked at an integrated health system and 19.0% at an independent acute care hospital. Specialty physician groups made up 4.0%, and so did other provider organizations. Of 142 who reported annual net patient revenue, 32.0% were above $5 billion and 27.0% were between $1 billion and $5 billion. Only 4.0% reported less than $25 million.
In the base of 154 who described their role, 28.0% were the primary decision maker on commercial payer contract strategy and 39.0% contributed to it. Another 21.0% had limited involvement and 12.0% had none. A small practice will differ from these respondents in size and staff. The leakage categories still apply to any group with commercial contracts.
Where revenue leaks, by risk
Respondents could pick more than one leakage risk. Two risks drew more than 60.0% each, and a third drew 42.0%.
| Revenue leakage risk | Share of 100 respondents |
|---|---|
| Payer policy changes not reflected in contracts | 68.0% |
| Inconsistent payment practices across payers | 64.0% |
| Methodology or payment logic changes by payers | 42.0% |
| Below-market contracted rates | 30.0% |
| Limited competitive rate visibility | 25.0% |
| Not sure | 9.0% |
Source: HFMA and Trek Health, Transparency in Coverage and Payer Contracting Strategy Survey Analysis, May 2026 survey, n=161 total, base=100 for this question.
Rate level ranked fourth. A below-market contracted rate was a leakage risk for 30.0%, less than half the share that named policy changes missing from the contract. For most of these organizations, the larger loss came from how a contract was applied after signing.
Forecasting reimbursement changes
HFMA asked how hard it is to forecast reimbursement shifts caused by rate changes, policy updates, or methodology changes. Of 96 respondents, 51.0% said it is often challenging and 11.0% said always. That is 62.0% combined. Another 28.0% said occasionally, 6.0% rarely, and 3.0% never.
A separate question asked how the organization anticipates the financial impact of payer policy updates. Of 100 respondents, 32.0% model the impact for select payers or service lines. Another 26.0% track and model policy changes across major payers. Reactive handling was common: 19.0% identify risk after the fact and struggle to put a dollar figure on it, and 14.0% usually find the impact after revenue has already changed. Another 7.0% were not sure and 2.0% chose other.
Put together, 58.0% had a modeling routine for at least some payers or service lines, and 33.0% worked reactively. A practice with a short list of payers can build the first routine at small scale. Record each policy notice, the date it takes effect, and the codes it touches. Then compare paid amounts before and after that date.
What limits action on rate data
The survey also asked what keeps organizations from turning transparency data into bargaining power. Of 100 respondents who could pick several answers, 44.0% cited limited time or analytic resources. Another 39.0% said the data exists but is hard to normalize or trust. Teams working in silos with disconnected tools drew 18.0%, and insights not tied to contracts or financial models drew 17.0%. Only 8.0% reported no significant limitation.
On how Transparency in Coverage data feeds negotiation preparation, the base was 101. The largest groups were 23.0% who use it to benchmark rates before negotiations and 23.0% who were not sure how it is used. Another 19.0% build it into financial modeling, 18.0% use it to set rate targets and strategy before talks begin, 11.0% do not use it, and 7.0% review it only for awareness.
Outside active negotiations, 31.0% of 96 respondents did not use the data at all. About 30.0% used it to monitor payer rate changes over time. Identifying underpayments or leakage was a use for 23.0%, and contract compliance and validation for 18.0%.
What a small practice can test
Medical groups report a similar gap. In a December 30, 2025 MGMA Stat poll with 207 applicable responses, 18.0% of medical groups used negotiated-rate data in payer contract talks, 46.0% did not, and 36.0% were unsure. MGMA listed lack of awareness, unclear value, and too little time, tools, or skills as the main barriers.
The HFMA figures suggest where limited time pays off first. Policy changes missing from the contract and inconsistent payment across payers both drew more than 60.0%. Both can be checked from remittance data the practice already holds, without a rate file.
Pick the five CPT codes with the highest paid volume. For each payer, list the contracted rate and the paid amount on the last 20 remittances. Flag any code where the paid amount differs from the contract on more than one claim in five. Take the flagged codes to the payer contract review first.
Sources
- HFMA, Transparency in Coverage and Payer Contracting Strategy Survey Analysis, August 17, 2026
- HFMA and Trek Health, Survey Analysis key findings deck, May 2026 survey
- MGMA Stat, Using TiC negotiated-rate data to negotiate smarter payer contracts, December 31, 2025
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