RCM Pulse Weekly

OBBBA Coverage Unraveling: 10–17M Medicaid Patients at Risk, $24B Uncompensated Care Projected • Cigna 70% PA Standardization by Year-End; Full Payer PA Scorecard • UiPath BOAT Full-Stack RCM Framework; 86% of Practices Leave Revenue on the Table • EEG Code Family Revisions & 6 New MRI-Safety CPT Codes 76014–76019 • Net Collection Rate Gap: 95%+ Target vs. 83–89% National Median • Fathom in Epic App Orchard; Nym Health Clinical Benchmark; 120+ AI Tools Commoditization Risk • OBBBA Provider Tax Freeze; Audio-Only Telehealth Restrictions; H2 2026 Compliance Calendar • Independent Practice: OBBBA Double Exposure — Medicaid & ACA Marketplace Panels at Risk

MA Network Crisis: 21 Health Systems Exit, 2.9M Enrollees Displaced • UHC 30% PA Reduction Rolling Out: Echocardiograms & Outpatient Surgery PA-Free for 50M Members • Black Book’s 9 Under-the-Radar AI Innovations: Governance Now the Differentiator • FY 2027 ICD-10: 238 New Codes Oct 1; GI Colonoscopy Denial Surge • Smarter Technologies $800M Launch: SmarterDx + Thoughtful.AI + Access Healthcare • Cybersecurity: TriZetto 2.5B-Transaction Breach; TiC Rule Proposed Update • Independent Practice: AI Governance Gap at 77%; M&A Accelerating

URGENT: CMS-0062-P Drug PA Rule Comment Deadline June 15 • Massachusetts Eliminates PA for Primary Care, Cancer Scans & Chronic Disease Meds • HFMA 2026: McKinsey Projects 30–60% Cost-to-Collect Reduction With AI; FinThrive Fusion & UiPath Agentic AI Debuts • Radiation Oncology Overhaul: Level 1/2/3 Replace Simple/Complex; IMRT 77385–77386 Deleted • Cardiology LAA Occlusion wRVU Cut 26.8%; PCI Family Revised • 2026 AR Benchmarks: Days in AR 30–40, Clean Claims ≥95%, AR Aging Ratios • Agentic AI RCM: $1.83B Market Growing to $19.71B by 2034 at 34.61% CAGR • Independent Practice: 30% Revenue Decline; Medicaid Risk Modeling for 2027 • Specialty: Primary Care PIN Codes, Cardiology LAAO Cuts, Oncology Coding Overhaul

CY 2027 MA & Part D Rule Effective June 1: Star Ratings Overhaul, PA Continuity & Part D Redesign • Medicaid Community Engagement IFR: 80 hrs/month Work Requirement, Jan 2027 State Deadline • athenahealth 80+ AI Features: 30% Coding Denial Recovery, 16% Fewer Insurance Denials, PA Voice AI <1hr • CoCM Billing Code Alert: 99492–99494 Retired, G0568–G0570 Required Now • Denial Rates Hit 20%; 60% Never Appealed; Prevention-First KPI Playbook • Black Book Research: 74% Shift to Denial Prevention, Revenue Cycle Now Board-Level Infrastructure • Price Transparency Enforcement Active; Drug PA Comment Deadline ~June 13 • Independent Practice: 15% AI-Integrated; Medicaid Panel Risk Modeling for 2027 • Specialty Spotlight: Cardiology UHC–NYP, Orthopedics −2.5% Cut, Mental Health Telehealth Expansion

CMS-2449-P: $775B Medicaid Supplemental Payment Cap Proposed • UHC Eliminates PA for 30% of Services: 50M Members, Echocardiograms & Outpatient Surgery First • Innovaccer Acquires CaduceusHealth $66M: First Autonomous RCM Platform for 4,000 Providers • CPT 2026 AI-Assisted Diagnostic Codes: Lung Nodule, Stroke AI, Mammogram Comparison Now Billable • 97% Clean Claims Benchmark: 0.3–0.5 AR Days per Point Below • CMS Price Transparency Enforcement Active: Median Allowed Amounts, Type 2 NPI, CEO Attestation Required • Independent Practice: 60% Denied Claims Never Resubmitted — $30K–$80K Recovery per Physician • Specialty Spotlight: Mental Health PA-Exempt, Radiology AI CPT Codes, Cardiology ASM Prep

ASM Mandatory for 8,600 Cardiologists & Back-Pain Specialists Starting Jan 2027 • Aetna 95%+ PAs in 24 hrs; Cigna Migrates to CoverMyMeds • RCM AI Market: $21B → $71B by 2031; Fathom Enters Epic App Orchard • ICD-10-CM FY2026: 487 New Codes — E11.A Diabetes Remission & HIV Z21 Now Audit Risk • Clean Claims Rate: 95% Floor, Zero-Day Denial as Gold Standard • UHC Mandates Full Radiology Interpretation Reports; Waystar IPO • $5.7B Healthcare FCA Recoveries FY2025 — HIPAA Tracking Tech Enforcement • 97% of Practices Outsource RCM; Only 15% AI-Integrated • Specialty Spotlight: Primary Care APM Premium, Cardiology ASM, Oncology CMS-0062-P Deadline

CMS Medicaid Managed Care Final Rule: Network Adequacy & PA Data Reporting Mandated • Gold Carding Expands: Cigna 15K+ Providers, Humana 3-Tier PA Reform • Agentic AI: AKASA 1-Agent = 14 Staff, Thoughtful AI 4.2% Denial Rate • HCC Risk Adjustment Gap: $2.8B Missed by Independent Practices • First-Pass Resolution Rate: The Hidden KPI • Payer AI Denial Engines vs. Counter-AI Platforms • OIG 2026 Work Plan: Telehealth, E/M & Medical Necessity Active Audits • MGMA 2026 Compensation: Independents Earn 12% Less • HPSA Bonus: 10% Medicare Bonus, 2,400 New Designations

CMS-0062-P Drug PA: 24-Hour / 72-Hour Decision Windows, Mandatory ePA by Oct 2027 • UHC Cuts 30% More PAs; Payer Pushback Drives 78% of Payment Delays • Oliver Wyman: 63% of Health Systems Run AI in RCM; Only 8% Expect “Very High” ROI • April 2026 ICD-10-CM Update: Opioid, Autoimmune & Post-COVID Codes • The 25-Day Club: Top Performers Cut Days in A/R Below 25 • CodaMetrix Cuts Coding Denials 59%; 2026 Best in KLAS RCM Winners • Hospital Price Transparency Enforcement Begins April 1 • Only 42.2% of Physicians Still in Private Practice

H.R. 1 Signed: Medicaid Provider Tax Freeze, Payment Caps & One-Year Medicare Lifeline • PA Reform Scoreboard: Aetna 88%, Cigna 70% • Waystar $1.25B Iodine Acquisition • CPT 2026: First AI-Augmented Billing Codes • Top Practices Collecting in Under 24 Days

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