VAB RCM

04/14/2026

Modern Healthcare just released the 2026 100 Top Hospitals® list. This annual program uses a data-driven methodology to identify the nation's top-performing hospitals, evaluating clinical outcomes, operational efficiency, financial health, and patient experience.

Also recognized is the Everest Award — a special distinction honoring hospitals that have achieved both the fastest rate of improvement and the highest current-year performance on the balanced scorecard over a five-year period.

Congratulations to all the hospitals and their boards, executives, and medical staff who earned a spot on this year's list.

For over 30 years, the 100 Top Hospitals® program has been producing annual, quantitative studies designed to shine a light on the nation's highest performing hospitals and health systems.

04/11/2026

Touchless Revenue Cycle
Healthcare revenue cycle management (RCM) remains one of the most labor-intensive and costly aspects of healthcare delivery. It accounts for 3–4% of a typical health system's net revenue, translating to more than $140 billion annually across U.S. systems. Traditional automation has delivered incremental gains, but persistent challenges such as high claim denial rates (averaging nearly 20%, with up to 60% never appealed), fragmented technology vendors, manual workflows, and rising labor costs continue to strain operations and delay cash flow.

Enter agentic AI, a significant evolution beyond generative AI. While generative AI primarily creates content or offers advisory insights, agentic AI consists of autonomous AI agents that can perceive, reason, plan, make decisions, and execute complex, end-to-end processes with minimal human supervision — essentially acting as a digital coworker. These agents learn from patterns in rules-based tasks, handle interconnected workflows, and operate under human oversight for exceptions, compliance, and refinement. In RCM, this enables a vision of a "touchless revenue cycle": a self-running system where administrative tasks flow seamlessly with little to no manual intervention, from front-end scheduling through mid-cycle documentation and coding to back-end claims and collections.

In their 2026 report, McKinsey points out that agentic AI offers the first credible path to truly tech-enabled RCM by shifting from narrow task automation to holistic workflow ex*****on. Initial deployments often focus on the back end — where processes are highly rules-governed, labor-intensive, and lower-risk — before expanding across the full cycle. Key use cases include:

Accounts receivable follow-up: Automating high-volume claim status monitoring and outreach to reduce labor hours while processing more claims accurately.

Underpayment and denials management: Identifying patterns, assembling appeal documentation, drafting submissions, and improving overturn rates.

Cash posting and collections: Handling routine payments and patient reminders, freeing staff for strategic work.

These applications leverage agentic AI's ability to orchestrate multi-step tasks, integrate with existing systems, and adapt based on outcomes. Over time, interconnected networks of agents could span the entire cycle — eligibility checks, prior authorizations, coding from clinical documentation, and patient billing — creating a more unified, efficient engine.

04/01/2026

More than 400 hospitals across the United States are at high risk of closing or cutting services because of the Medicaid cuts in President Donald Trump’s “big, beautiful bill.” The fallout could make it harder for millions of people to get care and put thousands of health care workers’ jobs at risk as hospitals lose a key source of federal funding. Medicaid covers about a fifth of all hospital spending.

The Medicaid cuts come in phases, with more significant changes, including work requirements, in 2027 and limits on how states raise funds in 2028. Overall, the law is expected to reduce federal Medicaid funding by roughly $1 trillion over the next decade.

“We’re seeing hospitals that are already under severe financial strain having to make decisions about how to stay financially solvent,” said Eileen O’Grady, a researcher in Public Citizen’s Congress Watch division and the report’s author. “That has pretty clear implications for people who live in that community. It also has ripple effects on other hospitals in those communities.”

https://www.citizen.org/article/big-ugly-threat/

03/25/2026

The American Medical Association’s 2026 Physician Survey on Augmented Intelligence has just been released. The results are in from over 1,600 U.S. doctors across every specialty and practice setting, and the message is clear: AI is no longer on the horizon—it’s already transforming day-to-day medicine. Adoption has doubled since 2023, with 81% of physicians now using AI in their practices and incorporating an average of 2.3 different tools. The biggest jump? Nearly 40% are already using AI to summarize medical research and standards of care—up dramatically in just the last year.
Overall sentiment continues to trend positive. Seventy-six percent of physicians say AI gives them a real advantage in caring for patients, especially when it comes to boosting work efficiency and sharpening diagnostic ability. Many also see huge potential for AI to ease burnout by handling clinical and administrative tasks that currently drain their time and energy.
At the same time, doctors are thoughtful about the risks. Patient privacy, the doctor-patient relationship, and the possibility of skill loss (especially among trainees) remain top concerns. Most physicians want strong safety validation, ironclad data privacy protections, and clear liability rules before going all-in. And 92% say they want more hands-on training and to be actively involved in deciding how AI is brought into their own practices.
In short, the survey shows growing optimism paired with a very practical call for responsible, well-supported adoption. AI in healthcare is here—and physicians are ready to help shape it the right way.
https://www.ama-assn.org/system/files/physician-ai-sentiment-report.pdf

03/21/2026

AMA Board Chair Testifies Before Congress on Health Care Affordability and Patient Access
On March 18, 2026, American Medical Association (AMA) Board of Trustees Chair David H. Aizuss, MD, a board-certified ophthalmologist with an independent multispecialty practice in Calabasas, California, testified before the U.S. House Energy and Commerce Subcommittee on Health at a hearing titled “Lowering Health Care Costs for All Americans: An Examination of the U.S. Provider Landscape.”
Representing physicians nationwide, Dr. Aizuss emphasized that health care affordability is inseparable from patient access. When physician practices face unsustainable financial pressures—such as market consolidation, stagnant payments, rising costs, burdensome regulations, and workforce shortages—patients suffer through reduced access, longer wait times, fewer local options, and higher overall costs as care shifts to more expensive hospital settings.
The testimony detailed how increasing consolidation in health insurance and hospital markets limits physician negotiating power, while Medicare physician payments have declined 33 percent when adjusted for inflation since 2001 despite rising practice expenses. Other key challenges include site-of-service payment disparities that favor hospitals, restrictions on physician-owned hospitals, administrative burdens (including prior authorization), potential disruptions to Medicaid and ACA coverage, and growing physician shortages, particularly in rural and underserved areas.
Dr. Aizuss called on Congress to take immediate action to support independent practices, preserve patient choice, and control long-term costs by:

- Establishing a permanent annual inflationary update for Medicare physician payments tied to the Medicare Economic Index (MEI);
- Reforming Medicare’s outdated budget neutrality requirements to prevent recurring arbitrary cuts;
- Overhauling the Merit-based Incentive Payment System (MIPS) to reduce administrative burdens, especially for small, rural, and independent practices;
- Passing H.R. 4002, the Patient Access to Higher Quality Health Care Act, to repeal Affordable Care Act restrictions on physician-owned hospitals and restore competition;
- Streamlining prior authorization processes and other administrative requirements;
- Addressing site-of-service payment differentials that accelerate consolidation;
- Expanding the physician workforce through increased Medicare-supported GME residency slots, rural training programs, Teaching Health Centers, and the National Health Service Corps;
- Ensuring Medicaid reforms preserve patient coverage while improving physician reimbursement (including a payment floor at Medicare rates) and reducing administrative hurdles to sustain participation.

During the hearing, members of both parties expressed bipartisan concern about inadequate Medicare physician reimbursement and its direct impact on the viability of independent practices, patient access, market competition, and overall health care costs. Broader discussions also addressed structural reforms to reduce consolidation, improve price transparency, and ease regulatory burdens on physicians.

AMA Board of Trustees Chair David H. Aizuss, MD, testifies on March 18, 2026, at a hearing before the House Energy and Commerce Subcommittee on Health.

02/21/2026

The Intelligent Billing Revolution: How AI and Regulation Are Reshaping Medical Revenue Cycles in 2026

The medical billing industry is undergoing one of the most significant transformations in its history. What was once a labor-intensive world of manual data entry and paper claims is rapidly giving way to intelligent automation, AI-driven audits, and a patient-first financial experience. In 2026, the forces reshaping revenue cycle management (RCM) are not incremental — they are structural.

From Suggestion to Autonomy: The Rise of Agentic AI

The most disruptive force in medical billing today is no longer AI that assists human coders — it is AI that acts independently. This new generation of agentic systems can autonomously analyze, flag, and in some cases resolve billing issues without human intervention.
Predictive denial engines now evaluate claims before they are ever submitted, identifying patterns that historically trigger rejections and allowing teams to correct errors upstream. This alone represents a fundamental reversal of the traditional denial management workflow, shifting the industry from reactive appeals to proactive prevention.
On the payer side, both CMS and private insurers are deploying their own AI systems to scrutinize claims for medical necessity in real time. The result is an environment where vague or incomplete documentation is no longer merely discouraged — it is immediately flagged, making hyper-specific clinical language a practical financial necessity.
Perhaps the most visible change at the point of care is the rise of ambient scribes: AI tools that listen passively to patient visits and automatically generate clinical notes and suggested billing codes. By removing the documentation burden from physicians, these tools are beginning to close the long-standing gap between care delivery and accurate billing.
The 2026 Code Revisions: Catching Up with Modern Medicine
The CPT 2026 and ICD-10-CM updates introduced hundreds of new codes that reflect how dramatically medical practice has evolved. Three areas stand out.
Remote patient monitoring has long been constrained by billing requirements demanding a full 30 days of data. New codes such as 99445 and 99470 now accommodate shorter monitoring windows of two to fifteen days, a change that aligns reimbursement structures with the clinical reality of acute conditions that resolve quickly.
For the first time, specific billing codes have been created for AI-assisted clinical services — including software that evaluates cardiac risk or tracks burn wound healing. This codification of artificial intelligence as a reimbursable service marks a turning point, legitimizing AI as a formal component of care delivery rather than a back-office tool.
Equally significant is the expanding role of Social Determinants of Health Z-codes. Payers are increasingly tying reimbursement to how thoroughly providers document and address patients' social circumstances — housing instability, food insecurity, access to transportation — signaling a deeper shift in what the healthcare system is being asked to measure and reward.

A Regulatory Landscape in Transition

The financial and legal environment surrounding billing is tightening on multiple fronts simultaneously.
Value-based care has reached what many in the industry describe as a tipping point. Payments are now meaningfully linked to patient outcomes rather than the volume of procedures performed, which means billing teams must track quality metrics alongside standard coding — a competency that traditional RCM departments were never built to provide.
At the same time, enforcement of the No Surprises Act is becoming more rigorous. Good Faith Estimates for self-pay patients and transparent pricing requirements are no longer treated as aspirational compliance targets; practices that fail to provide accurate upfront cost information are facing real consequences.
Perhaps most sobering is the increased False Claims Act scrutiny from the Department of Justice. Enforcement activity has expanded beyond classic upcoding schemes to include cybersecurity failures and billing errors generated or amplified by automated tools themselves — a development that places significant legal responsibility on organizations that deploy AI without adequate oversight.

The Patient as Consumer

Alongside these systemic changes, patient expectations around billing have shifted dramatically. Patients increasingly approach healthcare costs the way they approach any other financial transaction — expecting speed, transparency, and simplicity.
Billing platforms are responding by integrating with digital wallets such as Apple Pay and Google Pay, reducing payment friction to something comparable to an everyday retail purchase. Meanwhile, AI-generated plain-language billing statements are replacing the cryptic rows of procedure codes that have long mystified patients and eroded trust. The goal is straightforward: reduce confusion, reduce delay, and reduce the growing phenomenon of billing fatigue that causes patients to disengage from the payment process entirely.

A New Competency at the Core of Healthcare

Taken together, these changes suggest that medical billing in 2026 is no longer a back-office administrative function. It has become a strategic discipline that sits at the intersection of clinical documentation, regulatory compliance, technology governance, and patient experience. Organizations that treat it as such—investing in both the right tools and the human expertise to oversee them—will be far better positioned to navigate what is shaping up to be the most consequential decade in the history of healthcare finance.

01/30/2026

U.S. life expectancy rose to a record high of 79 years in 2024, an increase of six months from the previous year, reflecting a sharp decline in deaths from COVID-19 and drug overdoses, the Centers for Disease Control and Prevention said on Thursday.
According to a report from the CDC's National Center for Health Statistics, life expectancy improved for both men and women across races and among Hispanics, surpassing the previous peak set in 2014.

U.S. life expectancy rose to a record high of 79 years in 2024, an increase of six months from the previous year, reflecting a sharp decline in deaths from COVID-19 and drug overdoses, the Centers for Disease Control and Prevention said on Thursday.

01/28/2026

Medicaid covers one in five low-income Americans and faces significant pressures in 2026 due to a challenging fiscal environment and the implementation of changes from the 2025 reconciliation law. While major new federal legislation on Medicaid is unlikely, 2026 will involve federal guidance/regulations, state-level responses to budget constraints, and intersections with broader health policy debates (e.g., ACA premium tax credits expiring, drug pricing efforts) ahead of the November 2026 mid-term elections (including 39 gubernatorial races).
Key areas to watch:

Medicaid Coverage
States begin implementing 2025 reconciliation changes projected to increase the uninsured population by 7.5 million by 2034, with 5.3 million from new work requirements (mainly affecting ACA Medicaid expansion adults, effective January 1, 2027). Some states (e.g., Nebraska starting May 2026) may move early. Other changes include pausing certain Biden-era enrollment streamlining rules, restricting eligibility for some lawfully present immigrants, and more frequent redeterminations. Implementation requires major system changes, data sharing, and outreach, straining resources. Immigration policy shifts (public charge rules, data sharing, enforcement) and state decisions to roll back coverage for certain immigrants could further reduce enrollment.

Medicaid Financing
The 2025 law cuts federal Medicaid spending by $911 billion over 10 years, worsening state budget pressures amid slowing revenues. Key immediate impacts include bans on new or increased provider taxes (a key state funding mechanism), potentially forcing several states (at least CA, IL, MA, MI, OH, NY, WV) to revise arrangements by spring 2026. States may respond by cutting provider rates, optional benefits (e.g., some already dropped GLP-1 obesity drugs), or tightening eligibility. New Trump administration drug pricing models (GENEROUS and BALANCE) aim to lower costs for high-priced drugs like GLP-1s, with unclear but potentially positive effects on Medicaid budgets.
Access to Care
Financing constraints could lead to lower provider reimbursement rates, benefit restrictions (especially optional services like behavioral health or home/long-term care), and reduced provider participation (particularly affecting rural hospitals and high-Medicaid providers). Workforce shortages may worsen due to immigration policy changes (KFF data shows rising work avoidance among immigrants, who make up >25% of long-term care workers and hospital physicians). Section 1115 waiver policies may shift away from Biden-era priorities (e.g., less support for health-related social needs or workforce initiatives).

Overall, 2026 is a transitional year of implementation, state-level cost-control decisions, and potential coverage/access losses, setting the stage for bigger debates in the 2026 midterms and beyond. The combination of federal cuts, work requirements, and state fiscal realities creates a precarious environment for Medicaid enrollees, providers, and state budgets.

In this brief on Medicaid issues to watch for 2026, KFF explores how state fiscal pressures are likely to converge with the implementation of the 2025 reconciliation law to affect Medicaid coverage, financing, and access to care over the next year, especially leading up to the midterm elections.

12/26/2025

12/14/2025

More than 530,000 Michiganders currently rely on the health insurance marketplace for coverage. About 480,000 of them receive tax credits to help pay their premiums, according to the Michigan Health & Hospital Association. https://bit.ly/3YvHnaJ

12/13/2025

Effects of Inflation on Payment Behavior in the Medical Billing Industry in 2025
In 2025, inflation significantly strained patient payment behavior in the U.S. medical billing industry, primarily through elevated medical inflation (outpacing general inflation) and rising out-of-pocket (OOP) costs. General CPI inflation hovered around 3-4%, but healthcare-specific costs rose faster: medical care services increased ~4.2% year-over-year in mid-2025, while commercial group market trends reached ~8-9.7%. Global medical trends were even higher at ~10.4%, with U.S. employer-sponsored plans seeing substantial hikes.
Key drivers included:

Higher provider costs (labor, supplies, drugs) are passed to patients via high-deductible plans.
Increased utilization of behavioral health, specialty drugs (e.g., GLP-1s), and post-pandemic deferred care.

This led to notable shifts in payment behavior:

Increased Difficulty Paying Bills
—over 53% of Americans struggled with unexpected bills >$1,000 (or >$600 for lower-income/credit groups.
~86% reported rising prices made managing bills harder, with 30% draining savings and others using high-interest credit.

Delays and Non-Payment
Patient delays rose due to confusion (71% confused by bills) and affordability. Bad debt increased as providers shifted to upfront collections, point-of-service payments, and aggressive policies, turning manageable balances into uncollectible debt.

Higher Medical Debt and Collections
~36% of households had medical debt; 32-67% found inflation worsened bill payment (up from prior years). More bills entered collections, with routine visits contributing more to debt than hospitalizations.
Avoidance of Care
~One-thirddelayed/skipped care due to costs, exacerbating future expenses and bad debt cycles

Provider Impacts
Hospitals faced thin margins (e.g., 2.1% average), leading to more patient financing roles. Bad debt rose from self-pay-after-insurance (up to 57% of cases), prompting adoption of digital tools, AI analytics, and flexible plans to predict/recover payments.

Overall, 2025 saw a "triple whammy" of medical inflation, consumer inflation, and OOP shifts, eroding affordability and pushing patients toward delays, partial payments, or default—increasing industry bad debt while providers innovated with low/no-interest plans and transparent billing.

Forecast for 2026
Medical cost trends are projected to remain elevated in 2026, with limited relief from deflationary forces. Forecasts indicate:

U.S. healthcare costs rising ~9.6% (slightly down from 9.7% in 2025 but still high).
Global averages >10%.
Employer premiums up 6-9%.

Inflators persist: new technologies (74% of insurers cite as top driver), pharmacy/outpatient pressures, behavioral health (10-20% trend), and provider consolidation/labor costs.
Payment behavior is likely to face continued pressure:

Worsening Affordability and Delays
Premium/deductible hikes (e.g., Medicare Part B premium to ~$206.50) will strain households, leading to more delays, skipped care, and bad debt. Expiration of enhanced ACA subsidies could spike individual market premiums 18%+, shifting more costs to patients.
Rising Debt and Collections → Without major interventions, medical debt burdens (already affecting millions) may grow, with patients relying more on credit/plans. Providers may intensify upfront collections and digital engagement to mitigate.

Potential Mitigations
Biosimilars, AI for efficiency/fraud detection, and outcomes-based drug models could temper some costs. Flexible/no-interest plans and preventive focus may help, but structural issues (e.g., fee-for-service rewarding volume) suggest persistent challenges.

Industry Adaptations
Expect more predictive analytics for non-payment risks, personalized payment options, and outsourcing to reduce bad debt. However, if utilization and prices don't moderate, 2026 could see the sharpest employer cost jumps in over a decade.

In summary, while 2025 highlighted inflation-driven delays and rising bad debt, 2026 forecasts sustained high trends—likely prolonging cautious payment behaviors unless offset by policy changes (e.g., drug negotiations effective 2026) or broader cost controls. Providers and payers will increasingly prioritize patient-centric financing to maintain collections amid affordability strains.

12/03/2025

In the medical billing sector, revenue cycle management (RCM) continues to evolve amid rising healthcare expenditures, technological integration, and regulatory pressures. As of Q4 2025, the global medical billing market is valued at approximately USD 20.04 billion, reflecting a year-over-year growth of about 12% from 2024, driven by demand for outsourced services and digital tools. Key drivers include a projected compound annual growth rate (CAGR) of 12.17% through 2034, fueled by AI adoption and value-based care models. This update focuses on the most recent advancements, emphasizing compliance, efficiency, and patient outcomes to support billing professionals in optimizing reimbursements and minimizing denials.