At A Glance
Revenue cycle management (RCM) teams are facing a year of major change, with new regulations, tighter margins and the adoption of artificial intelligence (AI) increasing the pressure on workflows. This article outlines Experian Health’s five RCM predictions for 2026, along with tools to consider when building a resilient revenue cycle.
Key takeaways:
- Experian Health predicts a tougher year ahead as regulations tighten and financial pressure grows.
- AI adoption remains low, but uptake is increasing in high-volume use cases and areas like insurance eligibility, scheduling and registration.
- RCM leaders must take steps to clean up data and reduce manual workflows to be ready to adapt in 2026.
According to Experian Health’s latest revenue cycle management predictions, 2026 will not be business as usual for RCM teams. Sweeping AI adoption, regulatory pressures and squeezed margins will put operational adaptability to the test in the US healthcare industry. Instead of waiting for January to set their new year’s revenue cycle resolutions, providers should start now by cleaning up data and giving teams the technology they need to take on 2026 with confidence.
Prediction 1: Denials continue to rise, making prevention the top priority
Claim denials show no sign of easing up in 2026. In Experian Health’s latest State of Claims survey, more than one-third of providers report denial rates of 10% or more. Claim denials are one of the biggest drains on time and resources, which few organizations will want to tolerate in the busy year ahead.
Preventing denials starts with understanding the root causes, which often stem from registration errors and inefficient manual processes on the front end. However, artificial intelligence is already proving useful in this area. According to the survey, 69% of those using AI have experienced a reduction in denials.
Despite the promise of AI, adoption remains low. To move beyond pilot mode, providers need tools they can trust to simplify their workflows. This is what Experian Health offers with tools like Patient Access Curator™ (PAC) and AI Advantage™. PAC tackles denials from the front end, automatically correcting patient data so that claims are accurate from the start. Meanwhile, AI Advantage flags high-risk claims, allowing staff to identify and resolve issues before claims are submitted or reworked.
Prediction 2: New healthcare regulations drop extra demands on patient access
The One Big Beautiful Bill Act (OBBBA) is set to roll out in 2026, which is likely to increase the number of self-pay patients. The Congressional Budget Office anticipates that the number of uninsured Americans will increase by 10 million by 2034, putting pressure on patient access teams and billing departments. Experian Health’s survey on OBBBA suggests that many providers aren’t yet ready for the new regulations, with eligibility and billing jumping out as the top areas in need of attention.
To handle higher patient responsibility, providers need tools that streamline insurance eligibility verification and provide the most accurate coverage information in real-time. Patient Access Curator’s ability to validate accurate patient insurance information gives both providers and patients greater clarity about how bills should be paid. Other tools, like Experian Health’s Patient Financial Clearance and Collections Optimization Manager, offer additional support to help patients and minimizes the risk of uncompensated care.
Prediction 3: AI adoption picks up speed in RCM workflows
In the first half of 2026, caution about AI will give way to pragmatism. Experian Health’s new AI survey reveals that most US revenue cycle managers believe it may take a few years for AI to become standard practice. Specifically, 53% anticipate that AI will be widely adopted but will still require oversight, while 32% believe it will be essential for operational efficiency. Insurance verification, patient scheduling and registration top the list of early use cases.
High-volume tasks are natural starting points for teams that want quick, targeted wins. AI tools can enhance accuracy and identify patterns in data that are difficult for the human eye to see. Starting small will be a good way to help teams build confidence and skills before expanding the use of AI.
Prediction 4: Prior authorizations get a long-awaited upgrade
Authorizations have long been one of the most frustrating pain points for clinical and RCM teams. The new Interoperability and Prior Authorization Final Rule takes effect in January, promising faster decisions, greater transparency, and a more consistent experience with Medicare Advantage, Medicaid, the Children’s Health Insurance Program and exchange plans.
Experian Health’s Authorizations supports the transition by cutting the manual work associated with prior authorizations. It automates submissions and inquiries, guides users through an exception-based workflow, and stays current with the latest regulations and payer requirements. The result is a more streamlined process that keeps authorizations moving and meets the objectives of the new rules.
Prediction 5: Rural hospitals face a critical year
Recent reports suggest that up to 700 rural hospitals, nursing homes and clinics may face closure in the coming years. Lower patient volumes, staffing shortages and rising costs are all contributing to shrinking margins. Many facilities have already been pushed to reduce services, delay investments and make layoffs.
Balancing the books in 2026 will require rural providers to find new ways to generate revenue and control costs through telehealth models and partnerships with larger health systems. Tightening up collections is another practical step to support cash flow and ensure rural patients don’t lose local access to care.
What this means for RCM leaders
As Jason Considine, President at Experian Health, says: “Healthcare enters a pivotal year of regulatory change and accelerated adoption of new technology similar to the digital transformation during the pandemic. AI is proving its value in addressing long-standing issues like claim denials and administrative burdens, but adoption must be built on trust, transparency and accountability. Providers are bracing for the financial and operational effects of new legislation, making it critical to modernize systems thoughtfully to simplify healthcare for all.”
Predictions give a sense of where pressure is building, but as the industry saw during the pandemic, adaptability matters more than prediction when things are changing this quickly.
To hit the ground running in 2026, RCM leaders need to anticipate and prepare for new regulations, streamline front-end processes, and start using AI where it can save time and reduce errors.
Explore how Experian Health is reshaping the way health systems manage Coordination of Benefits. Learn how automation and AI are eliminating manual errors, reducing denials and unlocking millions in recoverable revenue.
FAQs
Start tightening eligibility and billing processes now, especially around patient access. Clearer coverage information and fewer manual steps make it easier to manage higher self-pay volume when the rules take effect.
High-volume, front-end tasks like eligibility, scheduling and registration are areas where AI can save time, reduce errors and free staff to focus on more complex work, even if full adoption takes time.
Experian Health tools such as Patient Access Curator, AI Advantage, Authorizations and Collections Optimization Manager increase accuracy and efficiency at key parts of the revenue cycle, helping teams reduce denials, accelerate reimbursements and improve the patient experience.
See how Experian Health is helping healthcare organizations use AI and automation to create a resilient revenue cycle.
