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AI and automation are already making progress in making the “touchless” revenue cycle a reality— where prior authorizations are processed instantly, and claims are resolved in minutes, not months. But are payers and providers ready to set aside their differences and align on governance?

Provider leaders are increasingly focused on strengthening their relationships with payers and are investing in AI, automation, and managed services to strengthen revenue cycle performance, according to a Guidehouse/HFMA survey. Our 2026 Revenue Cycle Management Trends report offers a glimpse into the investments they’re making and how health system leaders can improve performance at their own organizations.

Read the report to learn:
  • The top revenue cycle challenges facing health systems
  • How shifts in the payer-provider relationship are impacting the revenue cycle
  • How leaders are using AI and managed services to improve performance

Our findings

88%

say payer challenges are top concern

78%

are using automation and AI to speed up manual RCM processes

69%

are outsourcing all or part of their revenue cycle

About the report

What are the biggest revenue cycle pain points? accordion-circle-plus accordion-circle-plus-hover accordion-circle-minus accordion-circle-minus-hover
Our survey found that payer challenges remain a top concern, with 88% of executives ranking payer issues among their top three concerns. Leaders point to increased denials, prior authorization delays, unclear denial rationales, excessive documentation requests, and reduced reimbursement rates as behaviors impacting their A/R. Respondents also say their teams are struggling to contend with slow front-end operations and prior authorization, workforce shortages, compliance hurdles, and technology challenges.

While respondents reported a fairly wide distribution of final denial rates this year, the number of providers reporting denials over 5% nearly doubled to 20%, compared to 12% in our previous survey. Medical group and hospital executives were especially likely to report higher denial rates.

Providers are using managed services providers for a wide variety of revenue cycle services, but improving the speed and accuracy of reimbursement remains a top motivator for seeking out a third party.


  • 67% outsource accounts receivable follow-up and collections
  • 50% use outsourced coders
  • 39% outsource denials management
  • 29% outsource billing and claims editing

While our 2026 Healthcare AI Trends survey found that three out of four executives are currently implementing or have used AI in various functions, use of AI and automation may not be as common in the revenue cycle:

  • 59% of respondents said they haven’t yet implemented AI or automation in the revenue cycle, but
    • 42% are exploring it
    • 16% haven’t considered it

The report points to several levers providers can pull to improve yield and resilience:

  • Tighten payer relations and governance: Focus on clearer contracts, escalation pathways, and payer-specific playbooks.
  • Standardize processes and documentation: Invest in coding standards and documentation training to reduce avoidable errors and underpayments.
  • Use managed services strategically: Many providers now work with outsourcing partners who offer scale and specialized expertise.

Meet our experts

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Michael
Duke
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Partner, Health

Michael brings 30 years of experience helping clients maximize operational performance through the implementation of purpose-built advanced automation.

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Andrew
Hancock
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Partner, Health

As Payer/Provider Financial Solutions leader, Andrew brings close to 20 years of revenue cycle, managed care strategy, and clinical documentation expertise.

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Ian
Stewart
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Partner & Health Managed Services Leader, Health

A former provider executive, Ian brings 25 years of experience optimizing revenue cycle and business operations and consumer contact center solutions.

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