As 2025 draws to a close, healthcare providers find themselves at a significant juncture. The year brought accelerating challenges—rising denials and payer audits, payer technology advancing at unprecedented speed, and hospitals continuing to operate under financial strain.
Yet within these pressures emerged remarkable innovation, particularly in how artificial intelligence is transforming revenue cycle management from a reactive administrative function into a strategic competitive advantage.
We gathered insights from Aspirion’s leadership team to understand what defined 2025 and what healthcare organizations should prepare for in the year ahead. What emerges is a clear picture: technology adoption is no longer optional, and the gap between organizations that embrace AI-powered solutions and those that don’t will only widen in 2026.
The Technology Imperative: Matching Payer Capabilities
What Defined 2025
Denials are accelerating. The percentage of providers reporting denial rates above 10% has surged from 30% in 2022 to 41% in 2025. Payers are deploying AI systems that can review and deny claims in seconds—processing denials at scale and speed that manual provider workflows cannot approach. The result: growing operational strain, compressed margins, and more financial burden shifting to patients already struggling with medical costs.
And despite 69% of healthcare providers who use AI reporting that AI solutions have reduced denials and/or increased the success of resubmissions, only 14% of providers are currently using AI to reduce denials.
It’s become imperative for providers to close the technology gap.
Jim Bohnsack, Chief Strategy and Client Officer, saw technology development accelerate dramatically: “The speed of development by Aspirion’s AI, Engineering, and Product teams to address the majority of denial types with a continued increase in success rates was striking.” This wasn’t incremental improvement—it represented a fundamental shift in what’s possible when hospitals commit to systematic AI implementation.
Spencer Allee, Chief AI Officer, witnessed this transformation deliver measurable results: “2025 was the year we transformed our Denials Management services with AI at scale. The vast majority of our clinical appeal letters are now AI-assisted which has enabled us to address a larger range of denials for our clients with faster time to cash, fewer 2nd and 3rd level appeals, and higher success rates.”
What surprised Allee most was the quality improvement alongside speed gains: “We were happily surprised to see that our success rates when using AI tend to be ~10% higher than without, indicating that the quality of our services with AI embedded is increasing as well. The combination of deep subject matter expertise alongside the power of AI-enabled platforms outperforms either humans or AI on their own.”
Curtis McGinnis, Chief Technology Officer, reflected on the organizational transformation required: “We’ve been intentional about fostering fruitful relationships to facilitate impactful insights and trust, and we’ve double-downed on our commitment to helping our clients accelerate their business functions through automation. It has truly been an amazing year of evolution.”
Stacy Gearhart, General Manager of AR Management, noted similar momentum: “2025 was a pivotal year of focus and alignment. We sharpened our operating model to better support our clients, creating a stronger, more cohesive foundation.”
What’s Ahead in 2026
Bohnsack’s advice to hospital leaders is direct: “Payers are deploying technology at a rapid pace, providers need to do the same—license, partner, or outsource, but please do something to capture the revenue due to your organization.”
Allee’s warning is equally clear: “We expect to see AI continue to be operationalized on the payer side, driving the continued trend of increasing denials, downgrades, and underpayments. Providers need to have a strategy to take advantage of AI tools and services on their side to counteract the payer-side trends or they will fall further behind.”
McGinnis acknowledges the challenge while emphasizing the opportunity: “We’ll continue to witness advances in AI and automation at an unprecedented pace, in so many industries. I know automation can sound scary, and maybe threatening, but we must be willing to expand our minds to continue to push the possibilities of technology. This will drive the ability to optimize the workforce and put providers and patients in a far better position.”
Gearhart sees this modernization continuing: “In 2026, we’ll build on that momentum with continued modernization and alignment, bringing greater integration, consistency, and efficiency as we move forward.”
The Denials Crisis: No Longer a Human-Addressable Problem at This Scale
What Defined 2025
The denials landscape has fundamentally shifted beyond what manual processes can address. Traditional business office staff simply can’t handle the volume and complexity of today’s clinical denials, which requires specialized expertise (i.e., clinical, coding, legal). With each appeal demanding hours of work reviewing 500-plus page medical records, matching evidence against multiple rule sets, and building comprehensive clinical arguments, the economics of manual processing have broken down entirely.
Bohnsack identified the deepening challenge: “The increase in clinical denials accelerated throughout the year with payers continuing to shift to the use of technology to deny and/or downgrade.” While payers publicly reduced prior authorization denials by 7.7% in 2024, they simply moved the scrutiny. Medical necessity denials jumped 5%, and requests for clinical information increased 5.4%. Payers shifted from front-end controls to back-end payment integrity processes, deploying large language models to review clinical documentation after care has already been delivered.
The volume and complexity created what Bohnsack describes as “not a human-addressable problem anymore at this scale.”
Gloriann Sordo, General Manager of Denials, emphasized both the operational transformation and the human element: “We saw accelerated movement from manual, reactive denial work to more structured, technology-enabled workflows, with early AI and automation supporting prioritization and throughput.” But what surprised her most was “the pace at which teams adapt when the ‘why’ behind change is clearly communicated and leaders stay close to the work, while rebuilding the culture.”
What’s Ahead in 2026
Bohnsack sees the focus expanding: “There will be continued focus on getting providers reimbursed but with an added benefit of ensuring they get paid ‘correctly’ based on highly accurate, modeled managed care contracts.”
Sordo anticipates broader AI adoption but emphasizes the human element will remain critical: “We’ll see broader adoption of AI-enabled denials prevention and management, shifting work further upstream and reducing rework.” She warns that technology alone won’t succeed, pointing out that RCM leaders should also watch “how effectively their organizations balance technology adoption with culture, training, and psychological safety.”
Her recommendation? “Leaders should invest early in change readiness, communication, and leadership capability—not just in systems—to sustain results at scale.”
Payment Accuracy: The Hidden Revenue Opportunity
What Defined 2025
One of the largest revenue opportunities in healthcare exists where most organizations aren’t looking: in accounts already marked as closed. These zero-balance accounts appear resolved and complete in revenue cycle systems, yet analysis reveals that hospitals are systematically missing substantial underpayments. The problem isn’t that these discrepancies are impossible to find—it’s that traditional workflows don’t look for them, and manual review can’t economically justify the time investment required to identify payment variances in seemingly complete accounts.
Analysis of our nationwide client data reveals that 54% of zero-balance recoveries originate from unknown or under-worked denials—subtle payment discrepancies that require sophisticated contract analysis and clinical expertise to identify and recover. These aren’t obvious claim rejections that conventional denial management targets. They’re payment variances that escape detection because they require detailed contract modeling, precise clinical documentation review, and comprehensive understanding of payer-specific payment methodologies.
For Liana Hamilton, President and General Manager of Payment Variance Recovery, 2025 marked a year of building the foundation for transformation: “It has been a year full of change and challenges, but overall amazing and looking forward to a great 2026.”
Hamilton also experienced the power of AI in changing the economics of out-of-network recovery: “We use it to flag potential No Surprises Act claims earlier and generate payer-specific submission letters with relevant clinical details pulled directly from chart notes and cost data. That efficiency lets us pursue smaller-dollar claims we might have once skipped.”
The impact was dramatic, according to Hamilton: “With one health system partner, Aspirion used to set a $10,000 to $20,000 threshold for IDR due to the time and resources involved. With AI, we’ve been able to lower that amount significantly, making smaller claims worth pursuing.”
Today, that threshold sits at approximately $3,000. DocIQ—Aspirion’s AI tool that intelligently analyzes medical documentation and payer contracts to generate evidence-based appeals validated by experienced clinicians and legal professionals—helps determine the strength of each case to optimize which claims to pursue.
What’s Ahead in 2026
Allee sees payment accuracy as the next frontier: “2026 will be the year we transform not just appeal writing with AI but also pricing. We will utilize our AI-enabled pricing engine to automatically identify underpayments for our clients and maximize reimbursement at scale across all accounts placed with us —whenever the managed care contract is available.”
The opportunity is substantial. “Our data has shown 10%+ of all claims are underpaid by an average of 10-20%, which is a massive opportunity for any healthcare system with the capability to identify those underpayments at scale,” Allee notes.
Powering this shift to proactive payment accuracy is ContractIQ—Aspirion’s proprietary AI contract modeling and pricing tool—which transforms contract chaos into clarity. As the first of its kind, ContractIQ leverages AI and human expertise to fully extract contract pricing rules and reference data at scale—identifying and prioritizing every underpayment with complete accuracy and traceability.
Unlike traditional approaches, ContractIQ automatically ingests every payer agreement—extracting facilities, terms, dates, plan names, fee schedules, and reference data into a continuously updated rules database spanning government and commercial, inpatient and outpatient care settings.
Hamilton sees ContractIQ as transformative: “The rollout of ContractIQ will be a significant focus in 2026, enabling us to identify underpayments at a scale that was never possible before.” She emphasizes what hospital leaders should be on the lookout for: “What are the latest payer delay tactics and how can we identify and combat this behavior?”
For out-of-network recovery specifically, Hamilton’s advice is clear: “Treat out-of-network claims as a revenue opportunity worth the investment. The data shows that even small claims volumes can translate into millions annually when worked correctly.” With providers winning approximately 77% of NSA dispute cases and recovering more than $2.2 billion through IDR in just two and a half years through 2024, the strategic importance is evident.
The Convergence Point
Several themes emerge across these expert perspectives:
- First, technology adoption is no longer optional. Payers have already deployed sophisticated AI-powered systems and continue to move the goal posts on payment criteria, making it essential for providers to match this capability with AI that can spot and address these shifting tactics in real-time—or face widening competitive disadvantage.
- Second, successful AI implementation requires more than just technology—it demands organizational readiness, cultural adaptation, and sustained leadership commitment.
- Third, the combination of AI capabilities with deep domain expertise consistently outperforms either humans or technology operating independently.
For healthcare providers, the message is clear: 2026 will be defined by how effectively organizations deploy AI-powered solutions across the revenue cycle. Hospitals that successfully integrate technology with clinical and legal expertise, maintain focus on change management, and systematically address both obvious denials and subtle underpayments will capture substantial competitive advantage.
The infrastructure is built, the results are proven, and the opportunity is substantial. The question is no longer whether AI will transform revenue cycle management, but how quickly your organization will make the transition—and how much revenue you’ll leave uncaptured while deciding.
Ready to position your hospital for success in 2026? Discover how Aspirion’s proven AI-powered solutions, validated by deep clinical and legal expertise, are helping leading healthcare systems recover more revenue faster than ever before. Connect with us today.
