By Anurag Mehta, CEO and Co-Founder of Omega Healthcare.

Healthcare is being reshaped by persistent financial pressures, regulatory changes, and the rapid proliferation of AI. Revenue systems built for a slower, more predictable environment can no longer keep up. As the payer/provider dynamic becomes more complex, denials rise, and administrative burden grows. Therefore, static or fragmented workflows quickly become liabilities.

This constant firefighting forces organizations to have both eyes firmly fixed on the present to stay afloat, preventing them from looking to the future and ensuring their systems adapt. Said another way, both talent and financial resources are allocated to the here and now, versus allocating for building a truly tech-enabled revenue cycle system, and this misallocation risks long-term financial health.

I have worked in revenue cycle management (RCM) for over 25 years now, and I have long believed that technology is essential to success, and this belief has never been stronger. For the first time in the history of our civilization, real intelligence is available on demand and technology has now moved from optional to essential in RCM. Leaders are not adopting AI because it’s novel or cool. They are doing it because, given the way revenue operations are structured, it just cannot keep pace with the constant change to remain efficient.

An Everest Group report supported by Omega Healthcare, captured insights from 41 senior healthcare executives and RCM leaders on AI in RCM. An overwhelming majority (85%) expect AI, generative AI, and agentic AI to improve efficiency over the next five years. More than half are already testing or actively considering AI-driven use cases. This confidence is grounded in real operational exposure, particularly to the upstream breakdowns in eligibility, documentation, and authorization that determine revenue outcomes long before a claim is submitted.

As adoption accelerates, it has become clear that AI is not simply a technological upgrade inside RCM. It is an operating decision. The difference between AI that delivers meaningful improvement and AI that introduces new risks comes down to how intelligence is designed into workflows and how it is shaped by expertise.

AI Alone Can’t Deliver RCM Excellence

RCM is not a predictable, rules-based environment. It operates at the intersection of clinical nuance, payer/provider interpretation, regulatory oversight, and financial accountability. These variables vary by payer, provider, specialty, and patient context, often in ways that don’t lend themselves to simple automation.

That is why many early AI efforts struggle to scale. When intelligence is layered on top of existing workflows, teams are forced to reconcile machine output with real-world exceptions. Accuracy becomes inconsistent, adoption slows, and instead of reducing friction, AI introduces a new set of handoffs and checks.

The Everest Group’s findings closely align with what we see on the ground. Nearly 80% of healthcare leaders point to limited internal AI expertise as a key barrier, compounded by persistent issues with data quality, EHR integration, and regulatory complexity. These are operational realities that technology alone cannot work around.

What works in RCM is not AI replacing human judgment, nor humans simply validating AI outputs after the fact. What works is intelligence shaped by domain expertise from the start, so models reflect clinical reality and compliance requirements as they evolve. That expertise guides how risk is identified, how exceptions are handled, and how systems adapt over time.

What Actually Works in Real-World RCM Environments

Among the 51% of providers surveyed by the Everest Group who are actively exploring generative AI in RCM, whether through proof-of-concept testing or early deployment, gains are definitely emerging. Eligibility verification is becoming more accurate. Claims analysis is helping teams reduce avoidable denials. Documentation support is improving coding quality, while patient-facing interactions are becoming faster and more consistent.

These improvements are most visible when AI supports work earlier in the revenue cycle, where outcomes are shaped before issues cascade downstream. The focus is not on replacing teams or introducing new layers of oversight, but on helping staff get work right sooner, with clearer guidance and fewer corrections later.

This is the philosophy behind how we think about platforms like the Omega Digital Platform ®. Technology for technology’s sake is not the point. The point is embedding intelligence directly into the systems teams already rely on, so guidance arrives in context. Decisions improve earlier, and operations become more effective over time. Human expertise is what makes automation reliable, adaptable, and scalable. Omega Healthcare’s true differentiator is our immense depth of understanding developed over decades across various specialties and care settings, and our mission is to ensure this knowledge is leveraged to develop purpose-built technology that helps our team improve efficiency. At the end of the day, our only true KPI is creating the largest net increase in cash for our customers in the shortest time period, and I truly believe that our tech-enabled solution offers the lowest cost of ownership with the highest yield for customers. Instead of our customers needing to invest in adopting cutting-edge technology, we are committed to continuing our strong record of removing CapEx and drastically reducing OpEx for our customers and their revenue operations.

The Next Phase of RCM

Revenue systems built for static rules and one-time optimization will continue to fall behind. Payer requirements will always keep shifting. Documentation standards will evolve, and regulatory scrutiny will increase. In this environment, revenue operations must be designed to adjust continuously, using real-world signals to guide work earlier in the process and reduce downstream disruption.

This also requires a clear understanding of the role expertise plays alongside AI. As intelligence scales across the revenue cycle, expert teams must help shape how it is trained, governed, and applied. This ensures accuracy, compliance, and accountability as conditions change.

By 2030, AI and machine learning are expected to become the top investment priority for RCM leaders. At the same time, organizations are moving away from transactional approaches toward strategic partnerships that combine technology, operational rigor, and domain expertise to sustain performance as requirements evolve.

In this future state, RCM excellence will be defined by revenue operations that remain accurate and responsive even as complexity increases. Intelligence will need to live inside workflows, not alongside them, and expertise will need to be built into the system itself.

Revenue operations leaders should seek partners, not just vendors, who can bring the combination of human expertise, complemented by AI-powered excellence, to transform and elevate how their RCM can keep pace with an ever-changing environment.

By Heather Grey, SVP & GM, Camille McWhirter, VP of Sales and Taylor Elkow, Associate Director of Sales at Omega Healthcare.

Most patients receive care in community health centers, yet the vast majority of clinical trials still take place in large academic medical centers, creating major gaps in access, equity, and scientific validity. Expanding trials into community settings is essential to ensure therapies are tested in diverse populations.

In 2026 and beyond, AI will play a critical role in making trials more patient-centric and inclusive. Today, AI is no longer a vague, intimidating concept or an unknown looming in the background.

Instead, healthcare organizations are asking practical questions about how AI can empower them to improve trials. The ability to clean data more efficiently, support more clinical trials, and elevate the quality of research through AI implementation is very real today, something that simply wasn’t achievable in the same way even two years ago.

In addition to AI broadening access to trials, here are some other trends we expect to see within the clinical trials space in 2026.

Data volume explodes: As clinical trials increasingly extend beyond the four walls of academic medical centers, the volume of data generated is growing at an unprecedented pace. Traditional trials typically capture data at discrete study visits, but modern trials now collect information continuously, across days, weeks, or months, through electronic health records, remote monitoring tools, and patient-reported outcomes. This explosion of data has enormous potential to deepen clinical insights, but it also places new demands on trial infrastructure, analytics, and governance.

Clean data is essential: Real-world data (RWD) has become a cornerstone of clinical research, offering the ability to validate findings, inform trial design, and support more personalized treatment decisions. However, clean, usable data remains the exception rather than the rule. Researchers, principal investigators, and frontline clinicians alike often struggle with fragmented, inconsistent, and unstructured data that limits its practical value. As trials grow more data-intensive, the ability to transform raw information into reliable, FDA-grade datasets will be essential to maintaining scientific rigor, meeting regulatory expectations, and ensuring results can be audited and reproduced.

Growth in wearables: Wearable technologies and remote therapeutic monitoring are rapidly moving from niche tools to mainstream components of clinical research. Devices embedded in everyday life, whether dedicated medical-grade wearables or consumer technologies integrated with EHRs, are expanding how and where data can be collected. This trend is particularly powerful for community health centers and rural sites, which can now participate in research without requiring frequent in-person visits. As adoption grows, organizations will need clear strategies for validating, integrating, and governing this influx of device-generated data.

More decentralized trials: Decentralized and hybrid trial models are reshaping the patient experience and broadening access to research. Increasingly, patients can participate through home visits, telehealth appointments, and virtual check-ins rather than traveling to centralized research facilities. These approaches reduce burden on participants while generating highly data-rich insights across diverse populations and disease states. As this model matures, success will depend on strong operational support, seamless data flows, and consistent data quality across distributed settings.

How Omega Healthcare can help

As clinical trials become more decentralized, data-rich, and operationally complex, success increasingly depends on having the right combination of people, process, and technology behind the scenes. Omega Healthcare supports clinical trials, real-world data initiatives, and registries by addressing the operational challenges that most often delay or derail research. Trials frequently fail due to inconsistent data, staffing shortages, missed timelines, and lack of audit-ready processes. Omega Healthcare was built to solve those problems, helping research teams keep trials on track and bring therapies to market faster.

CurateIQ: Omega Healthcare’s CurateIQ platform bridges the gap between having large volumes of data and having data that is actually usable for research, regulatory submission, and AI initiatives. CurateIQ transforms raw, unstructured clinical data into research-ready, FDA-grade datasets held to 95% or greater accuracy. This work is performed by a large team of physicians, nurses, oncology specialists, and domain experts, with AI layered in to enhance, not replace, clinical expertise. The result is faster drug development, fewer downstream corrections, and data that is repeatable, auditable, and trustworthy. Importantly, Omega Healthcare does not retain rights to or copies of any data it touches; its role is purely to curate and structure data to meet each client’s specific needs, without data hoarding or resale.

AbstractIQ: In parallel, Omega Healthcare’s AbstractIQ and registry services help health systems meet growing compliance, reporting, and accreditation demands. Omega Healthcare’s registry experts and certified Oncology Data Specialists (ODS) manage organization-specific, centralized, and state-mandated registries, equipping clients with ODS-certified registrars to handle everything from case finding and abstraction to quality audits, outcomes reporting, and surveys. This support reduces backlogs, improves data quality, and ensures regulatory timelines are met across cancer, trauma, stroke, chest pain, bone marrow, and other registries. By integrating registry management with broader research and data curation services, Omega Healthcare enables health systems to reduce operational burden while strengthening the foundation for clinical trials and real-world research.

Together, CurateIQ and AbstractIQ help organizations turn data chaos into clarity — supporting cleaner data, stronger trials, and more equitable access to research across both academic and community-based settings.

Conclusion

In 2026, clinical trials will be defined by scale, complexity, and opportunity. Exploding data volumes, the rise of wearables, and the shift toward decentralized models are expanding what is possible, but only if data is clean, structured, and trustworthy.

Real-world data and AI are no longer abstract concepts; they are practical tools that can improve access, accelerate timelines, and strengthen scientific validity when applied thoughtfully. Organizations that invest now in data quality, operational infrastructure, and patient-centric approaches will be best positioned to run more inclusive, efficient, and impactful trials in the years ahead.

The financial landscape for healthcare providers continues to evolve — and not necessarily in their favor. 

Kaufmann Hall’s November 2024 Flash Report provides an at-glance positive outlook: Financial performance across 1,300 hospitals and health systems remained relatively consistent throughout the year. The data suggests that, following the historic lows of 2022, some providers are experiencing modest stabilization.

But, the reality is stark: Expenses are rising faster than revenue, and margin pressures remain a top concern. Workforce shortages, supply chain disruptions, rising payer scrutiny, cybersecurity threats — all these and more are shaping RCM trends into escalating challenges providers are struggling to address.

Read on to explore the key obstacles providers can expect to face this year — and how proactive revenue cycle strategies, automation, and tech-enabled expertise can help them stay ahead of the trends in 2025 and beyond.

Costs Will Continue to Outpace Reimbursements

According to the AHA, “cumulative underpayments in the second half of the last decade totaled more than half a trillion dollars — a nearly 40 percent increase compared to the first half, even after adjusting for inflation.” Medicare reimbursement for physician services followed a similar trend, declining 29 percent since 2001, when adjusted for inflation. 

As reimbursements shrink, costs are on track to see their sharpest increase in over a decade. According to recent PwC research, medical cost growth is projected to reach an 8 percent increase for the Group market in 2025 — the highest rate in 13 years.

The widening gap between reimbursement and costs leaves hospitals and health systems with fewer financial levers to pull. Many have already cut budgets, reduced non-essential staff, and renegotiated vendor contracts, but these short-term measures fail to address structural revenue cycle inefficiencies that contribute to financial strain.

What This Means for RCM

• Revenue optimization will be more critical than ever. With reimbursements failing to keep pace with costs, providers must ensure they are capturing every possible dollar. This means improving clinical documentation practices, strengthening coding accuracy, and improving charge capture to maximize revenue integrity.
• Denial prevention must be a top priority. On average, providers are spending $43.84 per claim — $19.7 billion a year — to adjudicate with health plans. With approximately 15 percent of all claims initially denied by private payers alone, hospitals should be conducting root cause analyses and front-end fixes to maximize clean claims rates.
• Smarter payer negotiations will be key. As Medicare Advantage plans and commercial payers tighten their reimbursement policies and increase clinical validation audits, providers must leverage data-driven insights to push back against underpayments and revenue loss.
• Staffing shortages will compound financial strain. Providers are still struggling to recruit and retain skilled RCM professionals, with many unable to afford competitive salaries or allocate resources for ongoing training. Without a sustainable workforce strategy, burden on existing staff will continue to grow, increasing denials and revenue leakage. Investing in staff upskilling and outsourcing both core and non-core RCM functions can help providers maintain efficiency despite staffing constraints.
• AI and automation will help offset rising administrative costs. In addition to RCM partnerships and training, providers need advanced technologies to streamline manual processes — from prior authorization workflows to payment reconciliation. Providers that integrate AI-powered tools and automations will be better positioned to reduce administrative overhead while improving accuracy as RCM complexity escalates.

Prior Authorizations Will Be a Thorn in Providers’ Bottom Line

Prior authorizations (PAs) are a moving target. Ongoing reforms, payer-driven automation, and provider pushback are shaping the current landscape — and driving future uncertainty.

Today, prior authorizations are, at best, a significant administrative burden and, at worst, a detriment to patient health outcomes. On average, providers are completing 43 prior authorizations per physician per week. According to a recent AMA survey, 95 percent of respondents reported that PAs somewhat or significantly increase physician burnout.

The impact extends beyond workflow inefficiencies. In the same AMA survey, 90 percent of respondents said that prior authorizations have a negative impact on clinical outcomes, and 87 percent reported they lead to higher overall healthcare utilization.

The financial strain is growing. PA-related denials are a leading cause of revenue cycle inefficiencies, with many overturned only after rounds of costly appeals. As payers lean further into AI to automate prior authorizations, providers will face more automated denials and fewer opportunities for real-time clinical review.

What This Means for RCM

• Automation on the provider side is essential. AI-powered tools can pre-screen PA requirements, reduce submission errors, and flag potential denials before they happen, helping providers stay ahead of payer demands.
• Data insights and streamlined appeals management will be key. As payers accelerate AI-driven denials, revenue cycle teams need tracking tools, automated appeals, and analytics-driven insights to push back on inappropriate denials.
• Regulatory shifts may ease — but not eliminate — the burden. New CMS regulations require faster response times and greater transparency for Medicare Advantage and Medicaid plans, but commercial insurers are not yet bound by these reforms. Hospitals must align internal workflows with evolving payer expectations to avoid disruptions.

Providers Will Have to Weed Through the AI Hype

AI and automation dominate discussions around RCM modernization, but real-world adoption remains uneven. A new Everest report, supported by Omega Healthcare, revealed an overwhelming majority (85 percent) of senior healthcare executives surveyed believe AI will improve RCM efficiencies over the next five years. Of those surveyed, more than half (51 percent) are either actively testing proof-of-concept (PoC) initiatives for gen AI in RCM (22 percent) or are in the consideration stage (29 percent), evaluating use cases and implementation challenges. 

The potential for AI is clear: Automating high-volume, repetitive tasks such as eligibility checks, claims status verification, and payment posting can reduce administrative burden and improve cash flow. 

But, adopting and fully optimizing that potential will continue to be a challenge for providers. A recent survey found that while some providers are leveraging AI-enabled technology services, such as gen AI and agentic AI, to streamline RCM, many still lack the internal resources and infrastructure necessary to incorporate it with broader operational success. 

What This Means for RCM

• AI adoption must be strategic. While AI has the potential to alleviate RCM operational challenges, its success depends on how well it is integrated into existing workflows. Revenue cycle leaders should prioritize AI applications that provide tangible, immediate value, such as denial prediction models, intelligent claims scrubbing, and automated prior authorizations​.
• AI works best when paired with operational expertise. Many providers struggle with limited IT resources and high implementation costs, making AI adoption complex. Partnering with tech-enabled RCM experts can bridge skill, expertise, and technology gaps, delivering cost reductions through AI-driven automation, workflow and resource optimization, and change management support.​
• Payers are using AI to their advantage. Insurers are leveraging AI to automate prior authorizations, medical necessity reviews, and claim denials at scale. Without AI-powered countermeasures, providers risk higher denial rates and prolonged reimbursement delays​.
• Not all AI solutions deliver on their promises. Vendors frequently market unproven tools with unclear ROI. AI should not exist as a standalone tool. Organizations must evaluate vendors carefully, ensuring AI solutions align with long-term revenue cycle goals rather than adopting technology for its own sake.​

Cybersecurity Threats Will Continue to Escalate

Cyberattacks targeting healthcare organizations are more frequent, sophisticated, and financially devastating than ever before. 

The sequence of infamous ransomware attacks over the past few years underscore a growing reality: Healthcare is a prime target for cybercriminals. According to the Federal Bureau of Investigation’s 2024 cybersecurity report, ransomware is now considered a persistent national security threat, and healthcare ranks among the most at-risk industries​. In 2024 alone there were 181 confirmed ransomware attacks on healthcare providers. The average ransom demand was $5.7 million; the average ransom paid was $900,000.

What This Means for RCM

• Cybersecurity is no longer optional — it’s an ethical and financial imperative. Beyond the immediate impact of a breach, cyberattacks cripple revenue cycle operations. Recent attacks have halted provider payments for weeks, delaying reimbursements, increasing administrative costs, and forcing hospitals to find alternative cash flow solutions​. Investing in cybersecurity now will prevent financial losses — and breaches of patient trust — down the line.
• Healthcare organizations must scrutinize vendor security practices. RCM leaders must demand higher security standards from third-party partners. Ensuring compliance with HITRUST and Zero Trust frameworks should be a top priority when selecting technology providers​.
• Training and internal policies are just as critical as technology investments. Many breaches result from human error, phishing attacks, or weak internal controls. Regular staff training, simulated cyberattack drills, and strict access controls are essential to mitigating risk​.

Patients Will Shoulder More of the Financial Burden

The financial responsibility for healthcare is shifting to patients. High-deductible health plans (HDHPs) are becoming table stakes, requiring individuals to pay more out of pocket before insurance coverage kicks in. Co-pays and co-insurance rates are also rising, further increasing patients’ financial strain.

This trend isn’t new — but it is accelerating. And, patients are feeling the financial squeeze. A 2024 KFF report found that:

• One in four adults postponed or skipped necessary care last year due to cost concerns.
• 21 percent of adults did not fill a prescription because of cost; many others turned to over-the-counter alternatives.
• More than half of insured adults worry about affording their monthly premiums and out-of-pocket costs.

As reimbursement rates stagnate, providers could be left with a growing pile of unpaid patient balances and uncompensated care, forcing them to write off more bad debt.

What This Means for RCM

• Cost transparency will become a competitive differentiator. Patients want to understand their bills upfront, but many providers still lack clear, patient-friendly pricing tools. Hospitals should prioritize self-service portals, cost estimators, and financial counseling options to help patients plan for expenses.
• Flexible payment options will be essential. With patients taking on more financial responsibility, hospitals should offer personalized payment plans, automated payment reminders, and digital financing options to reduce bad debt and improve collections.
• Proactive patient engagement will be key. The more touchpoints a provider has before a bill is due, the higher the likelihood of timely payment. This means early outreach, clear explanations of financial responsibility, and digital payment solutions will be crucial to maintaining cash flow.

Looking Ahead: How to Thrive in 2025 and Beyond

The trends of 2025 are the same RCM challenges providers have been facing for years. But, providers have the potential to be better equipped, now more than ever, to meet them. With the right strategies, technologies, and partnerships, hospitals and health systems can turn financial pressures into opportunities for growth and efficiency.

Innovation is no longer just a competitive advantage — it’s a necessity. AI-driven automation, smarter payer negotiations, and proactive patient engagement can help providers move beyond reactive cost-cutting and toward a more resilient, future-ready revenue cycle.

There’s opportunity in transformation. Providers that embrace change with intention will not only withstand today’s challenges but emerge stronger, more agile, and better prepared for what’s ahead. The future of RCM isn’t about survival — it’s about strengthening the foundation for long-term success.

Ready to Strengthen Your RCM Strategy?

With clinically enabled, technology-led RCM solutions, Omega Healthcare delivers the smart, strategic, end-to-end solutions providers need to drive efficiency, automation, and financial resilience — all while keeping patient care at the center.

Let’s build a stronger, more sustainable future for your revenue cycle. Learn more about Omega Healthcare’s provider services.