InSights 

A Message from Gene Spirito

In today’s environment, staying “mostly compliant” or “reasonably efficient” just isn’t enough. I speak with revenue cycle leaders every day who are trying to answer the same questions:

“What’s changing in 2026?”
“Where are we vulnerable?”
“How do we keep revenue predictable?”

That’s why we built RCM InSights — a digest of what’s real, what’s urgent, and where leading organizations are taking action. If your team is evaluating how your revenue strategy stacks up — or where gaps might be hiding — this issue delivers both insight and direction.

Let’s take a look at the forces shaping 2026 and how ADS can help you get ahead of them.

Prior Authorization Reform Didn’t Eliminate the Burden — It Made It Operational

There’s a dangerous misconception circulating: that interoperability mandates are removing prior authorization. Not so. They’re codifying it — and turning it into a permanent operational fixture.

The smartest organizations in 2026 are approaching PA like a core clinical workflow. Here’s how they’re staying ahead:

• Proactively gathering required clinical elements at the point of intake
  
  
• Standardizing handoffs between scheduling, clinical, and billing teams
  
  
• Leveraging AI tools to flag payer-specific requirements in real time and reduce human error

The result? Fewer delays, more approvals, and a staff that spends less time on phone calls and faxes.

Explore how ADS applies AI to real-world RCM processes. Not sure if you’re using tools like this yet? We’ll show you how it works.

Flat Reimbursement. Rising Risk. And Real Margin at Stake.

Medicare’s 2026 fee schedule? Mostly stagnant. Meanwhile, costs continue climbing — and revenue volatility is becoming the norm.

But here’s the good news: you may not need more revenue. You need fewer leaks.

According to MGMA: 3–5% of total net revenue is lost each year due to preventable RCM breakdowns.

Where it goes: - Denials that never get appealed
- Underpayments that fly under the radar
- Documentation gaps that delay reimbursement

The most successful practices in 2026 are focused on tightening processes, not expanding teams. They’re using analytics and automation to plug revenue leaks before they hit A/R.

See how ADS reveals and resolves revenue leakage. You might already be experiencing these gaps — we can help you assess where leaks are happening.

Payer Transparency Exists — But Most Practices Still Can’t Use It

Thanks to federal mandates, payer reimbursement rates are now public. But here’s the catch: access doesn’t equal insight.

MGMA reports fewer than 1 in 4 practices are using these published rates to:

- Benchmark contract performance
- Spot payer underpayments
- Fuel renegotiation strategies

And why? Because most don’t have the systems to operationalize the data.

That’s a missed opportunity — and a competitive disadvantage heading into 2026.

Let ADS turn your payer data into real-world margin improvement. We’ll walk through what you have now and what insights you’re missing.

Fraud Headlines Aren’t Just for the Bad Actors

In 2025, OIG enforcement jumped 18% year-over-year — targeting telehealth documentation, overuse of templated notes, and weak medical necessity support.

These aren’t abstract risks. They’re signals.

For compliant organizations, it’s not about fear — it’s about readiness. That means: - Strengthening documentation templates

- Embedding medical necessity logic
- Auditing workflows now, not after a payer flags you

Smart teams are building discipline into their systems before the audits show up.

See how ADS helps you design for compliance — not just respond to it. Curious what’s already possible with today’s AI-powered documentation tools? Let us show you.

Your 2026 Readiness Checklist: 5 Things to Do Now

Want to stay ahead this year? Don’t wait for problems to reveal themselves — go looking. Start here:

1. Denial pattern report for Q4 2025 — spot shifts before they spike
   
   
2. Benchmark payer turnaround times — especially for top-volume contracts
   
   
3. Audit pre-auth success rates by service line or location
   
   
4. Review underpayment trends — what’s slipping through unnoticed?
   
   
5. Map your intake-to-submission workflow — and flag manual bottlenecks

Talk to ADS about a customized revenue readiness review

Final Thought: Don’t Let 2026 Happen To You

The rules have changed. Revenue cycle is now a real-time sport — and margin control is the name of the game.

With ADS as your partner, you’re not just reacting. You’re leading.
We combine decades of healthcare IT expertise with today’s tools to help you: - Boost collections

- Cut denials
- Improve predictability
- Reduce burnout across your team

Let’s talk about what’s next — and how we can help you get there.

Schedule a discovery call now