By the end of 2025, most health systems and medical groups were not asking how to get back to “normal” revenue cycle operations. They were asking a harder question: which changes were temporary, and which had permanently rewired payer behavior, patient expectations, and RCM workflows.
COVID‑19 and its variants created massive volume shocks, forced rapid adoption of telehealth, pushed staffing models remote, and accelerated the shift of financial responsibility from payers to patients. Those dynamics did not reset in 2026. They continue to drive denials, cash flow volatility, and margin pressure today.
This article looks back at the most consequential 2025 revenue cycle trends, but through the lens that matters to executives now: which patterns have persisted, how they affect your AR and denial profile, and what practical steps you can take to build a more resilient revenue cycle.
1. Telehealth Moved From Exception To Core Revenue Stream
In early 2024, telehealth felt like an emergency patch. By late 2025, it was a permanent fixture in many specialties, especially behavioral health, primary care, endocrinology, and certain surgical follow ups. Payers introduced temporary flexibilities, then gradually hardened them into more formal coverage policies, often with narrower rules.
Why it matters: Many organizations still treat telehealth as an edge case inside their revenue cycle. That leads to avoidable claim rejections, inconsistent charge capture, and misaligned patient estimates. Given that telehealth can account for 10–40 percent of visit volume in some practices, treating it as “miscellaneous” is a direct hit to revenue integrity.
Revenue and cash flow impact:
- Higher initial denial rates for virtual services when POS, modifiers, or payer specific requirements are wrong.
- Underbilling when providers default to lower intensity codes for telehealth, even when documentation supports higher levels.
- Delayed patient collections when estimates fail to incorporate virtual visit benefits and telehealth cost sharing rules.
Operational implications:
- Your charge description master and telehealth fee schedules must be actively managed, not “set and forget”.
- Front desk and scheduling teams need payer specific telehealth rules baked into eligibility and estimation workflows.
- Clinicians require training on documentation standards for virtual visits, including time based coding and consent requirements.
What providers should do next:
- Build a telehealth RCM playbook by payer and by specialty. At minimum, document allowed CPT/HCPCS codes, required modifiers, covered POS codes, and typical denial reasons.
- Run a denial drill down on the last 90 days of telehealth claims. Quantify the denial rate, top reason codes, and recovery lag. Use this as a baseline KPI and aim to reduce telehealth denials to parity with in person visits.
- Integrate telehealth specific rules into your practice management or rules engine so that errors are caught at scheduling or charge entry, not by the payer.
A number of organizations now treat telehealth as a dedicated “line of business” inside their revenue cycle, with separate work queues and reporting. That level of focus is what tends to separate those who see telehealth margins erode from those who convert it into a stable, predictable revenue stream.
2. Automation Left The Pilot Phase And Became A Core RCM Capability
By 2025, the conversation about automation in revenue cycle management shifted from “should we try robotic process automation” to “where should we apply it first, and how do we govern it.” Staffing shortages, rising wage pressure, and volatile volumes all pushed leaders to look for non FTE ways to handle repetitive work.
Why it matters: Automation is no longer a differentiator by itself. The differentiator is how intelligently you deploy it. Uncontrolled automation can create “silent failures” that increase denials at scale. Thoughtful automation, on the other hand, can free scarce staff to work complex, high value tasks.
Revenue and cash flow impact:
- When eligibility checks, pre claim edits, and status inquiries are automated and accurate, first pass resolution rates climb and DSO drops.
- When bots blindly post remittances or update demographics without rules and audit trails, you can see spikes in downstream denials and compliance risk.
Operational implications:
- RCM leaders must think like product owners. Each automated workflow (for example, eligibility, denial routing, refund processing) needs clear business rules, owners, and KPIs.
- IT and revenue cycle must work as one team. Shadow automation projects inside single departments often break integration with EHR and PM systems.
- Staff require reskilling. Analysts and specialists need to learn to monitor, tune, and exception manage automated processes, not just perform manual steps.
A practical framework for RCM automation:
- Identify high volume, rules based tasks: eligibility checks, claim status inquiries, COB requests, low balance write off reviews, batch payment posting.
- Quantify the workload: measure staff time spent, error rates, and denial volume linked to these steps.
- Define “guardrails”: specify when automation should stop and send a case to a human, for example, when payer response codes are ambiguous or when payment variances exceed a threshold.
- Pilot and monitor: start with a single payer or specialty, then track first pass rates, rework volume, and net collection impact before scaling.
Organizations that treated automation as a continuous improvement program, not a one time project, came out of 2025 with leaner operations and better financial stability, despite intense staffing volatility.
3. The Patient As Primary Payer Became A Central RCM Challenge
Long before 2024, high deductible health plans were shifting financial responsibility to patients. What changed by 2025 was scale and sensitivity. Many households were still recovering from job loss or income disruption. At the same time, employers continued to favor benefit designs that pushed more cost sharing to employees.
Why it matters: In many ambulatory practices, 20–30 percent of net patient service revenue is now tied to patient responsibility. In some specialties, it is higher. Poor patient financial engagement is no longer a minor leakage. It is a primary driver of bad debt and write offs.
Revenue and cash flow impact:
- Unexpected bills trigger nonpayment, disputes, and negative satisfaction scores that affect referrals and online reputation.
- Manual, paper heavy patient billing processes lengthen collection cycles and drive up cost to collect.
- Weak propensity to pay screening leads to wasted staff time chasing balances that are unlikely to be recovered.
Operational implications:
- Financial clearance is no longer an optional front office nicety. It is a core RCM function that should be measured and managed.
- RCM teams must coordinate closely with patient access, scheduling, and digital teams to present clear, consistent financial expectations before services.
- Charity care and financial assistance policies need to be updated and operationalized at scale, not just documented for compliance.
A practical patient financial engagement checklist:
- Eligibility and benefits verification with a focus on remaining deductible and coinsurance for the specific service line.
- Real time, or near real time, estimates that factor in payer specific contractuals and recent utilization.
- Clear scripting for staff to explain estimates, options for deposits, and payment plans before service.
- Self service payment tools that allow patients to set up plans without calling your business office.
- Propensity to pay segmentation so that high risk accounts route to financial counseling early instead of late stage collections.
Many organizations that stabilized patient AR after 2025 treated this as a design problem, not only a collections problem. They redesigned end to end patient financial journeys, then measured success using KPIs such as patient POS collection rate, days from statement to payment, and percentage of encounters with an estimate generated before service.
4. Workforce Disruption Normalized Remote And Hybrid Revenue Cycle Models
By late 2025, most revenue cycle leaders had learned a hard truth. The staffing models that worked in 2019 could not simply be reactivated. Turnover was higher, wage inflation was intense in certain markets, and talented billers and coders now expected some form of remote or hybrid work.
Why it matters: Revenue cycle is process driven and data intensive. When remote work is done poorly, breakdowns in communication and oversight show up quickly as aged AR, unworked denials, and incomplete follow up. When done well, remote models can give you access to broader talent pools and extended coverage without sacrificing control.
Revenue and cash flow impact:
- Inconsistent remote processes often correlate with spikes in unbilled claims, missed timely filing windows, and delayed secondary billing.
- Well structured remote teams can reduce vacancy related revenue loss and overtime costs.
Operational implications:
- You cannot rely on “hallway conversations” or tribal knowledge. Workflows and escalation paths must be documented and available in shared systems.
- Productivity and quality metrics must be transparent and reviewed consistently. Remote teams need clarity about expectations, not just trust.
- Security and privacy controls must extend to home environments, including device management, VPN usage, and monitoring of access to PHI.
A simple framework for remote RCM governance:
- Standardize work queues: Define queue ownership, aging thresholds, and daily work expectations for each role, for example, number of follow ups per day by payer segment.
- Metric based oversight: Track per FTE productivity by task, denial overturn rates, and touch to resolution times. Share dashboards weekly so issues are visible early.
- Structured communication: Replace ad hoc chats with scheduled huddles, case review sessions, and clearly defined channels for urgent issues.
- Security by design: Collaborate with IT to enforce device encryption, screen privacy measures, and restrictions on local storage or printing.
Some organizations chose to partner with external billing firms rather than rebuild large internal teams. For those exploring that path, platforms like Billing Service Quotes can help compare vetted medical billing companies based on specialty, size, and operational fit without weeks of outreach. Whether you build in house or outsource, the lesson from 2025 is the same: workforce strategy is now a foundational part of revenue cycle strategy.
5. Denials Became More Sophisticated And More Resource Intensive
Payers used 2024 and 2025 to update medical policies, recalibrate prior authorization requirements, and refine automated claim editing. Many of those changes landed in production in late 2025. The result was not just more denials, but more complex denials that required clinical input, multi level appeals, or careful coordination with referring providers.
Why it matters: A rising share of denials are now “revenue integrity” or clinical validation issues, not just demographic or coding mistakes. Treating all denials as generic “rework” hides the fact that you may need different skills and escalation paths for clinical, technical, and administrative denials.
Revenue and cash flow impact:
- High dollar clinical denials tie up cash for months if there is no structured, prioritized appeal process.
- Appeal fatigue is real. When staff are overwhelmed, they often focus on lower complexity, lower yield denials, which hurts net collections.
- Unanalyzed denials lead to repeated upstream errors, creating a cycle of waste.
Operational implications:
- Denial management has to move from “back end firefighting” to a continuous feedback loop across patient access, coding, and clinical operations.
- You may need dedicated teams for clinical denials, separate from general AR follow up, especially in high acuity service lines.
- Physician engagement is essential. Many payer disputes cannot be resolved without clinician documentation changes or peer to peer discussions.
A denial prevention and recovery framework:
- Segment denials by type (eligibility, authorization, medical necessity, coding, bundling, COB) and by payer.
- Prioritize by net collectible value and appeal success likelihood, not just count.
- Assign clear ownership for each denial segment. For example, eligibility denials to patient access leadership, clinical validation denials to a joint CDI and utilization management group.
- Establish prevention projects whenever a specific denial type crosses a threshold. For instance, if authorization denials for imaging exceed a set percentage of volume, convene a cross functional task force to redesign that workflow.
Organizations that internalized this discipline after 2025 often saw double digit reductions in denial write offs and improved net revenue yield, even when payer policies continued to tighten.
6. Compliance And Data Security Risk Expanded With Digital And Remote Care
As more work shifted online (telehealth encounters, remote coding, home based RCM staff), the risk surface for privacy and security incidents grew. At the same time, regulatory bodies continued to refine guidance on telehealth, information blocking, and electronic access to patient data.
Why it matters: Revenue cycle teams sit at the intersection of PHI, billing data, and payer communications. Weak controls in RCM operations can create both financial and regulatory risk, especially when staff or vendors work in distributed environments.
Revenue and cash flow impact:
- Security incidents can disrupt claim submission, clearinghouse connectivity, or payment posting while systems are investigated or restored.
- Regulatory penalties or payer audits can have direct financial consequences if patterns of noncompliance are identified.
Operational implications:
- RCM leaders must be part of security and compliance planning, not just recipients of policies from IT or legal.
- Vendor oversight needs to extend to offshore or remote billing partners, including SOC reports and clear incident response protocols.
- Staff training must include both coding and billing compliance and practical security behaviors in remote environments.
Practical steps for RCM risk management:
- Conduct an annual risk assessment focused on revenue cycle workflows: access controls, data export patterns, payment card handling, and vendor integrations.
- Document and test your revenue cycle business continuity plan. Include scenarios such as system downtime, clearinghouse disruptions, and temporary loss of remote access.
- Integrate compliance checkpoints into existing QA processes. For example, include validation of telehealth consent language or modifier use in routine coding audits.
Organizations that used the disruptions of 2025 as a catalyst to tighten RCM governance now have fewer surprises when payers audit, regulators update rules, or new digital initiatives roll out.
7. How RCM Leaders Can Turn 2025 Lessons Into A Forward Looking Strategy
The trends that emerged or solidified in 2025 are not temporary anomalies. Telehealth, automation, patient responsibility, remote staffing, and complex denials now define the operating environment for revenue cycle teams.
To translate those lessons into a stronger financial posture, leaders can focus on a few cross cutting priorities:
- Build an integrated front‑end: Align patient access, financial clearance, and clinic operations around shared KPIs like clean claim rate, authorization success, and patient POS collections. The more that goes right before claim submission, the less you will spend on back end rework.
- Treat data as an operational asset: Standardize denial, AR, and productivity reporting. Use this to identify where automation helps, where staffing is misaligned, and where payer specific strategies are needed.
- Be deliberate about partnerships: If you supplement internal teams with external billing support, choose partners who can plug into your workflows, not replace them blindly.
If your organization is evaluating external revenue cycle support to accelerate these changes, choosing the right billing partner is just as important as optimizing internal workflows. We work with platforms like Billing Service Quotes, which help healthcare organizations compare vetted medical billing companies by specialty, scale, and operational needs without weeks of manual outreach.
Regardless of your mix of internal and external resources, the core objective remains the same. You need a revenue cycle that can handle volatility in volume, payer rules, and staffing without losing control of cash flow and compliance.
If you are ready to reassess your current revenue cycle strategy, realign around these structural trends, and identify the highest impact projects for the next 12 to 24 months, you do not need to do that in isolation. You can start by contacting our team to discuss your specific denial profile, payer mix, and operational constraints. Use our contact form to connect with revenue cycle specialists who work every day with independent practices, medical groups, hospitals, and billing companies on these exact challenges.
