Sixty-nine percent of hospitals and medical groups outsourced at least part of their revenue cycle in 2026, according to Guidehouse and HFMA's 2026 Rev Cycle Trends Report. Accounts receivable follow-up and collections topped the list of outsourced functions at 67%, ahead of coding at 50%.
What Practices Are Sending Out the Door
The 69% figure covers respondents outsourcing all or part of the revenue cycle, so most practices are mixing in-house staff with outside vendors rather than handing the whole function over. Accounts receivable follow-up and collections lead at 67%, the function that demands steady phone and portal work chasing aging claims. Coding follows at 50%, a reflection of how hard certified coders have become to keep on staff, since coding requires ongoing certification and payer-specific rule updates that a small practice cannot always train for in-house.
Denials management sits lower, at 39%, and billing or claims editing is the function practices are least likely to send out, at 29%. Those last two numbers suggest practices still want direct control over anything that touches active appeals or claim edits before they go out. For a billing company managing several client practices, that ranking is close to a checklist of where a new client is most likely to ask for help first.
Why Payer Friction Is Driving the Decision
Payer-related friction is a main reason those functions moved outside the practice. Denials, prior authorization delays, and documentation demands ranked among the top three concerns for 88% of the executives Guidehouse and HFMA surveyed. The same report found that 20% of providers now report a final denial rate above 5%, nearly double the 12% who reported that rate in the prior survey wave.
A denial rate that doubles the share of practices above a 5% threshold changes the math on outsourcing. Appeals and resubmissions take specialized staff time that a small practice often cannot spare, so paying a vendor per claim can cost less than carrying an underused in-house denials team. Documentation demands add a separate layer of cost, since each additional payer request for records or clinical notes pulls a biller or a clinical staff member off other work until the file is complete.
Where the Leak Starts First
MGMA's Jan. 6, 2026 poll of 288 medical group leaders asked where revenue cycle leakage originates inside their organizations. Denials and appeals accounted for 48% of reported leakage, more than triple the next category. Front-end issues, such as eligibility and registration errors, accounted for 23%, the kind of mistake that starts at check-in and is not caught until a claim comes back denied weeks later.
Billing and collections problems accounted for 14%, coding errors 13%, and charge posting mistakes just 2%. That breakdown lines up with the outsourcing pattern above: practices are outsourcing accounts receivable follow-up and coding, the two functions tied most directly to where MGMA's poll respondents said the money actually disappears.
| Revenue cycle function | Share outsourcing it, 2026 |
|---|---|
| Accounts receivable follow-up and collections | 67% |
| Coding | 50% |
| Denials management | 39% |
| Billing and claims editing | 29% |
Source: Guidehouse and HFMA, 2026 Rev Cycle Trends Report.
AI Adoption Trails Outsourcing
Automation is spreading unevenly alongside outsourcing. Seventy-eight percent of the executives in the Guidehouse and HFMA survey said they now use automation or AI to speed up manual revenue-cycle processes. At the same time, 59% of respondents said they have not yet implemented AI or automation in the revenue cycle overall, a group split between 42% who are exploring it and 16% who have not considered it.
MGMA's leakage poll points to a similar gap in where AI investment actually lands. Of the medical groups that expanded AI tool use in the past year, 68% put that investment into ambient documentation, scribing, and note-taking tools. MGMA's own respondents had already named claims and denials workflows, at 48%, as the source of the biggest leaks, a different target from where the AI spending concentrated. That gap gives billing companies an opening to differentiate on revenue-cycle automation specifically, rather than compete only on ambient documentation tools that many EHR vendors already bundle in.
The Market Behind the Shift
The move toward outsourcing and automation is happening inside a healthcare revenue-cycle-management software market that GlobeNewswire projected would grow from $40.58 billion in 2026 to $57.35 billion by 2030, a compound annual growth rate of 9.5%, in a report published Sept. 1, 2026. That report profiled 21 vendors, including Epic, Optum, Oracle Health, and R1 RCM.
A market growing at that pace gives practice administrators a larger field of outsourced vendors to compare against an in-house hire each year. It also means a vendor contract signed a year ago may already sit behind what a competitor now offers. Practices that renew RCM contracts on autopilot risk missing features, like denial-prediction models or automated eligibility checks, that a newer entrant to that 21-vendor field already builds in by default.
What the Numbers Mean for a Practice Decision
Put together, the two surveys point to the same split. Practices keep judgment-heavy work, like active claim edits and denial strategy, in-house at higher rates than repetitive, high-volume tasks like AR follow-up and coding. A denial rate climbing toward 20% above the 5% threshold, and 48% of leakage tracing back to denials and appeals, both help explain why 39% of practices already outsource denials management specifically, even though it ranks below AR and coding on the overall list.
For a billing company or practice manager building next year's budget, the 67%-50%-39%-29% ranking works as a prioritized list of where outside help pays off first. Reviewing a vendor's AI roadmap against that same list, rather than a generic feature sheet, is a reasonable filter for the next contract cycle.
Sources
- Guidehouse, 2026 Rev Cycle Trends Report (with HFMA), 2026
- MGMA Stat, Detecting and fixing leaks across the revenue cycle, January 6, 2026
- GlobeNewswire, Healthcare Revenue Cycle Management Software Market Report 2026, September 1, 2026
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