As the end of 2025 approaches, the operating environment for healthcare organizations remains essentially unchanged from the previous year.

Many system financial leaders continue to grapple with rising costs, workforce shortages, increased compliance burdens, and growing patient expectations.

For example, 2025 year-to-date hospital operating margins ticked up just 1% through May compared to the previous year, according to data from Kaufman Hall. While net operating revenue per calendar day was up 7% over the same period, this gain was offset by 7% growth in expenses per calendar day.

In particular, costs for supplies (27%), drugs (25%), and purchased services (24%) have soared in 2025 when compared with 2022, fueled by an aging population and greater use of specialty pharma products. Labor costs have risen more modestly (9%), but the supply of healthcare workers remains a challenge.

Across the nation, there is a projected 10% shortage of registered nurses in 2027, with the shortfall expected to remain until at least 2037, according to the National Center for Health Workforce Analysis. Similarly, demand for licensed practical and vocational nurses (LPNs) is projected to grow faster than supply through 2037, when the projected supply of LPNs will meet just 64% of demand.

Amid this challenging financial and operational climate, organizations must also remain focused on meeting rising consumer expectations. Conditioned to expect personalization, customization, and convenience, patients now increasingly anticipate the same levels of service from their healthcare providers as they do other industries.

However, it's important to note that things aren't all doom and gloom. For example, Fitch Ratings recently revised its healthcare sector outlook to “neutral” from “deteriorating” in 2024.

Plus, when it comes to operations and finances, traveling in a circle isn't such a bad thing. We've been down this road before, so we likely have a strong idea of what's up ahead.

With that in mind, the following are four predictions for revenue cycle management (RCM) in 2026, along with thoughts on how to navigate them:

• Automation has to be specialty-aware to deliver optimal ROI.
  
  To address their distinct operational and billing complexities, many specialty providers are implementing intelligent, specialty-specific RCM automation tools designed to streamline staff workflows and elevate the patient financial experience. Specialty healthcare providers encounter an array of procedure-specific codes, payor policies, and documentation standards; unlike the centralized billing systems and uniform workflows of hospitals or primary care, they require customized RCM solutions.
  
  These tailored strategies are essential for ensuring billing accuracy, speeding reimbursements, and maintaining financial resilience. For example, ambulatory surgery centers (ASCs) and orthopedic practices contend with distinct RCM challenges. ASCs, in particular, must juggle numerous surgical procedures spanning various specialties, with each carrying its own billing intricacies. Efficient claims processing and proactive denial management are vital to sustaining revenue and ensuring consistent cash flow.
  
  
• Predictive intelligence is king in RCM.
  
  AI-driven predictive intelligence has already become indispensable in RCM, empowering healthcare organizations to proactively identify financial and operational risks before they escalate. Using these tools gives departments the advantage of prevention over correction, which helps cut costs and accelerate revenue recovery.
  
  Advanced dashboards and financial performance trackers can highlight trends in reimbursements, underpayments, and coding variances, giving RCM leaders a clear picture of what to fix and where to focus. These platforms also flag high-risk claims and assist staff in prioritizing follow-ups, reducing time-to-resolution, and improving cash flow. Pattern recognition capabilities can detect the subtle issues in claim lifecycles, enabling teams to intervene early and prevent repeat problems. Predictive intelligence isn't just a technology feature; it's a competitive necessity.
  
  
• Patient financial engagement is a revenue driver, not just a service line. 
  
  With patients responsible for a growing share of healthcare costs, improving financial engagement is no longer a courtesy; it's a critical revenue strategy. Those organizations that invest in tools to help patients understand their bills, estimate costs upfront, and navigate payment options tend to collect more, faster. Digital-first billing platforms, mobile payment reminders, and personalized financial counseling not only improve collection rates but also reduce confusion and frustration, which are leading causes of delayed payments and poor satisfaction.
  
  The consumerization of healthcare has reshaped patient expectations across the board, and financial touchpoints are no exception. A seamless, transparent financial experience can enhance patient loyalty and brand reputation just as much as clinical excellence. Those who treat patient financial engagement as a strategic priority will be better positioned to thrive in a value-conscious healthcare environment. Ultimately, meeting patients where they are financially is key to both organizational stability and patient engagement.
  
  
• Regulatory complexity and compliance monitoring will only increase. 
  
  As the regulatory landscape grows more intricate, organizations face mounting pressure to keep pace with shifting payor policies, CMS guidelines, and varying state-level mandates. Payors are increasingly leveraging automation to enforce prior authorization rules and claim edits, making it even easier to deny payments for minor noncompliance issues. At the same time, CMS continues to release more granular documentation and billing requirements, raising the bar for accuracy and timeliness.
  
  This evolving environment increases the risk of revenue loss due to overlooked regulatory updates or inconsistent compliance monitoring. AI tools offer new opportunities to ensure documentation is audit-ready and coding is accurate, but their use will also invite greater scrutiny around transparency, fairness, and auditability. Departments that proactively invest in robust compliance infrastructures now will be best equipped to adapt quickly to regulatory shifts and avoid costly penalties. In 2026 and beyond, effective compliance monitoring will be just as essential to revenue cycle performance as claims processing itself.

Conclusion 

As healthcare organizations continue navigating high operating costs, workforce shortages, and rising patient expectations, staying ahead of billing and coding trends is essential for financial success. Specialty-aware automation, predictive intelligence, patient-centric financial engagement, and robust compliance monitoring will be critical RCM priorities in 2026. Those who embrace these strategies will be better positioned to thrive in an increasingly complex and competitive healthcare landscape.

Robert Marinich is a senior vice president of growth at SYNERGEN Health, a leading provider of revenue cycle management solutions for healthcare providers. With over 20 years of experience in the healthcare and technology sectors, he is passionate about creating new market opportunities and developing untapped revenue potential for his clients. 

https://www.synergenhealth.com/