Denials and underpayment management top the list of revenue cycle risks for 2026, named by about 62% of more than 120 revenue cycle leaders in the Adonis report Inside RCM 2026. A separate HFMA survey analyzed by Guidehouse found that 88% of providers say claim disagreements keep them from being paid on time and in full.
The Adonis survey counts the obstacles leaders expect. The HFMA survey counts the changes they already see in daily work.
What leaders rank as the biggest obstacles
Adonis, a revenue cycle software vendor, surveyed more than 120 RCM leaders for Inside RCM 2026. Revenue Cycle Advisor reported the results on February 25, 2026. The article does not state when the survey ran. Respondents named the obstacles they expect to limit revenue growth in 2026.
| Expected 2026 obstacle to revenue growth | Share of leaders | Source |
|---|---|---|
| Denials and underpayment management | About 62% | Adonis, Inside RCM 2026 (120+ leaders) |
| Payer reimbursement pressure | 46% | Adonis, Inside RCM 2026 (120+ leaders) |
| Staffing constraints | 44% | Adonis, Inside RCM 2026 (120+ leaders) |
Source: Revenue Cycle Advisor, February 25, 2026, reporting Adonis data. Staffing sits 18 percentage points below denials in this ranking.
The same report asked what hurt growth and collections in 2025. Frequent changes to payer adjudication rules led at 48%. Denial volume and complexity followed at 45%, and payer reimbursement levels and contract terms at 43%. Rule changes ranked above denial volume.
How much time denials take and what leaders can see
Most Adonis respondents said their teams spend 51 to 75 hours per week on denials-related work. At 40 hours per full-time employee, that equals 1.3 to 1.9 full-time positions, by simple division. Over 52 weeks the range is 2,652 to 3,900 hours a year. For a practice with a three-person billing office, that is a large share of paid hours.
Visibility is the second problem. In the same survey, 38% of leaders listed a lack of real-time visibility into payer performance as one of the top three factors affecting revenue growth and collections. Nearly half said centralized visibility is a very important part of their 2026 strategy. Adonis did not publish an exact figure for that group.
A team that spends 51 or more hours a week working denials has little time left to look for patterns by payer or code. A report that groups denials by reason and payer shows where those hours go.
What HFMA respondents report about payer behavior
Guidehouse published its analysis of an HFMA survey on April 1, 2026. The release does not state the sample size or the fieldwork dates. It reports that 88% of providers say claim disagreements prevent timely and full payment.
Leaders also described how payer behavior has shifted. The table shows the share who reported each change.
| Change leaders report | Share of respondents | Source |
|---|---|---|
| Increase in denials | 81% | Guidehouse, HFMA survey |
| Increase in prior authorization delays | 74% | Guidehouse, HFMA survey |
| Unclear denial reasons or underpayments | 73% | Guidehouse, HFMA survey |
| Excessive information requests | 69% | Guidehouse, HFMA survey |
| Reduced reimbursement rates | 41% | Guidehouse, HFMA survey |
Source: Guidehouse, April 1, 2026. Reduced rates ranked last, 40 points below the increase in denials.
The survey also measured final denial rates, meaning denials that stay unpaid after appeals. Twenty percent of respondents reported a final denial rate above 5%, up from 12% the year before. That is an 8 point rise in the share of organizations above the 5% line. Guidehouse says the rates were widely distributed, so many organizations remain below it.
Technology and outsourcing use
Guidehouse reports that nearly 60% of executives have not put any AI or automation into revenue cycle operations. Another 39% are implementing point solutions, which handle one task such as eligibility checks. Only 2% have fully or mostly integrated these tools across the revenue cycle.
Outsourcing is more common than automation. According to Guidehouse, 66% of providers outsource all or part of their revenue cycle to a managed services vendor, and the release ties that choice to workforce shortages. By subtraction, 34% keep the whole cycle in house and handle denials work with their own staff. The Adonis survey found the same pressure, with 44% of leaders naming staffing constraints as a 2026 obstacle.
Numbers a practice can check against its own
Five comparisons come from these surveys. Most practice management systems already hold the data for each.
- Final denial rate: compare it with the 5% line in the HFMA survey, where 20% of respondents were above it.
- Hours per week spent on denials: compare with the 51 to 75 hour range most Adonis respondents reported.
- Share of denials with an unclear or missing reason: 73% of HFMA respondents saw this increase, so a practice can count how many of its own denial codes carry no usable detail.
- Information requests: 69% of HFMA respondents reported excessive requests, so a count of requests per 100 claims by payer shows where the extra work comes from.
- Time lost to payer rule changes: 48% of Adonis respondents said rule changes hurt 2025 collections, so a log of rule changes by payer and date gives a practice a record to match against denial spikes.
Adonis is a software vendor, and the Guidehouse release gives no sample size. Neither source describes how respondents were chosen. A practice can run each comparison on its own claims from the last twelve months.
Sources
- Revenue Cycle Advisor (HCPro), Report: Denials, visibility gaps are top RCM risks for 2026, February 25, 2026
- Guidehouse, 2026 revenue cycle trends from the HFMA survey on payer relations, April 1, 2026
Talk to us
Fifteen minutes about your practice and the systems you run.