RCM Pulse Weekly

CMS CY 2027 MA Final Rule Takes Effect; Price Transparency Enforcement Active as of April 1 • AHIP Spring PA Progress Report Due: Reform Pledges Meet the Reality of Still-Rising Denials • Agentic AI Arrives: Waystar Claims $15.5B in Prevented Denials; Only 15% of Providers Fully Integrated • ICD-10-CM Note Changes Now Live in 14 Chapters; Cardiology PCI Overhaul and New AI Diagnostic CT Codes • The 25-Day A/R Target: How Top Performers Are Widening the Gap in 2026

CMS Drops Drug PA Interoperability Rule; H.R. 1 Puts Medicaid Eligibility on a New Clock • The MA Denial Crisis Deepens: 56% Jump in PA Denials, 80.7% Overturned on Appeal • Ambient AI Delivers Measurable Revenue Lift: 11% wRVU Gain, 14% More HCCs Documented • New CPT Codes in Play: AI-Enhanced Cardiac CT Billable, RPM Splits, GI and Neurology Updates • The MA Denial Tax: $47 Per Claim — How Rework Costs Are Eroding Revenue Velocity

Hospital Price Transparency Enforcement Is Live — What Every Practice Must Know Now • PA Reform Wave Continues: UHC, Cigna, Aetna Deliver on January Commitments • Agentic AI Is No Longer a Pilot — Autonomous Revenue Cycle Operations Go Mainstream • April 1 ICD-10-CM Update: Instructional Note Changes That Will Shift Your Coding • Closing the Gap: 2026 RCM Benchmarks and the Revenue Velocity Playbook

CMS Drops CY2027 MA Final Rule and April 1 ICD-10 Notes Reshape Coding — A Week of Back-to-Back Regulatory Moves • PA Transparency Era Begins: March 31 Deadline Forces Payers to Publish Denial Data for the First Time • AI Is Becoming the Revenue Cycle Operating System — Agentic Workflows Now Handle the Full Denial Loop • April 1 ICD-10 Update: No New Codes, But Excludes1-to-Excludes2 Conversions Could Unlock Missed Revenue • Days in A/R, Denial Rates, and Clean Claims: Where the Industry Stands Heading Into Q2

CMS Finalizes Electronic Claims Attachments Rule — $782M in Annual Savings, Fax Machines on Notice • March 31 PA Metrics Deadline Looms as Payers Publicly Report Denial Data for the First Time • HIMSS26 Unleashes Agentic AI Arms Race — Waystar, Epic, and FinThrive Ship Autonomous RCM Agents • 36 New HCPCS Codes Drop April 1 — Plus Critical ICD-10 Excludes 1 Enforcement at UHC • Days in A/R Benchmarks Tighten as Denial Rates Hit 11.8% and $262B in Claims Go Unpaid

Regulatory/Payment Updates — CMS PFS Correction Rule and Part D Out-of-Pocket Cap Take Effect • Prior Authorization / Payer Relations — AHIP Voluntary PA Reforms Now Live; Payers Trim MA Networks • AI & Automation Deep Dive — Agentic AI Crosses Into Autonomous Revenue Cycle Operations • Coding Updates — CPT 2026 Coronary Revascularization Overhaul and Radiation Oncology Code Restructure • Revenue Velocity / KPIs — Zero-Day Denials and the Race to Sub-30 Days in A/R

Medicare Advantage Plans Cut Benefits and Geographic Coverage for 2026 • Prior Authorization Real-Time Decision Mandate: 80% by 2027 • Healthcare Eligibility Verification Automation: 60-90% of Verifications Now Autonomous • FY 2026 ICD-10-CM Guidelines: Major HIV Coding Revisions Take Effect • RPA Adoption in Revenue Cycle Management Reaches 50-75% of U.S. Hospitals

CMS Physician Fee Schedule 2026: 3.26% Rate Increase and Key Payment Updates • Prior Authorization Reform Takes Effect: Industry-Led 72-Hour Response Commitment • AI-Powered RCM Reaches Critical Mass: 63% of Providers Already Using AI • CPT 2026 Recognizes AI-Augmented Services for the First Time • Denial Rates Surge to 15%: AI Denial Prevention Becomes Standard Practice

Medicare Advantage Market Disruption: 10% of Enrollees Forced to Switch Plans • RADV Audits Accelerate: Payment Year 2020 Reviews Now Underway • The Autonomous Coding Revolution: AI Medical Coding Market Update • ICD-10 and CPT 2026: Critical Guideline Changes You May Have Missed • Denial Management in 2026: Upstream Prevention Replaces Downstream Recovery

CMS 2026 Payment Updates: What Your Practice Needs to Know • Prior Authorization Reform: 50+ Payers Commit to Major Changes • AI and Automation: The Agentic Revolution in RCM • CPT and ICD-10 Code Updates for 2026 • Revenue Velocity: 7 KPIs Every Practice Should Track