Report: Denials, visibility gaps are top RCM risks for 2026

Recent findings from revenue cycle management (RCM) software vendor Adonis shine a light on healthcare organizations’ top risk and readiness concerns for 2026. Based on survey responses from over 120 RCM leaders, the report revealed insights into why payer pressure is currently the primary driver of revenue risk.

When asked what about the three factors that had the most significant impact on their organization’s ability to grow and collect revenue in 2025, most respondents said frequent changes to payer adjudication rules (48%), denials volume and complexity (45%), and payer reimbursement levels and contract terms (43%).

The survey also asked respondents to look ahead and predict the top three factors that will be their biggest obstacles to revenue growth in 2026. Approximately 62% said denials and underpayment management, 46% said payer reimbursement pressure, and 44% said staffing constraints.

This data shows that payer behavior has overtaken internal constraints as the top barrier to growth, according to the survey analysts.

“While staffing constraints and workflow inefficiencies remain real challenges, they are increasingly overshadowed by external forces that limit predictability and control,” reads the report. “This shift marks a departure from prior years, where internal optimization was viewed as the primary lever for improvement. In 2026, revenue performance is increasingly dictated by payer behavior rather than patient volume or internal capacity.”

 Another key insight from the report is that increasing visibility gaps are forcing RCM teams into “reactive mode.” While healthcare organizations often invest in analytics and reporting tools, 38% of respondents listed a lack of real-time visibility into payer performance as one of the top three factors impacting their ability to grow and collect revenue. Nearly half of survey respondents said having centralized visibility across the revenue cycle was a very important component of their 2026 strategy.

When healthcare organizations have these wide visibility gaps, they are often only able to address issues after the financial impact has occurred, which creates additional operational burden. The majority of respondents indicated that their teams spend between 51 and 75 hours per week on denials-related work, which equates to roughly 108-162 full days per year.

Revenue cycle professionals can read the report in full to learn more.