Healthcare practices are facing growing pressure as medical billing and revenue cycle management become harder to sustain internally. Rising claim denials, tighter payer requirements, authorization delays, and staffing constraints are disrupting cash flow across specialties. This article examines why getting paid has become more difficult heading into 2026 and how practice leaders can gain clarity on what revenue is still recoverable before it expires.
When UNC Health and Cigna failed to reach a contract agreement, 60,000+ North Carolina patients were left scrambling. But the deeper lesson isn’t just about one health system — it’s about how downcoding, administrative overload, and payer tactics are threatening revenue and continuity of care nationwide. This post breaks down the real risks, early warning signs, and how providers can proactively protect their revenue and patients before their own contracts are at risk.
Aetna’s CCRP quietly began downcoding high-level E/M claims in March 2025, joining Cigna’s R49 policy effective Oct 1. Providers face hidden revenue loss, delayed payments, and rising admin burden. Learn how Downcoding Defense™ tools protect your practice.
Sep 29, 20256 min read
In fact, one healthcare provider we worked with achieved 132% of monthly collection goals.
⚠️ Is Your Practice at Risk?
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I'll help you identify:
✓ Hidden revenue leaks in your payer contracts
✓ Downcoding exposure you might not see
✓ Early warning signs of contract breakdown
