The plumbing of a medical practice’s revenue cycle is rarely without a defect somewhere. Sometimes it can seem like a slow drip, and often you may not even know where the drips originate — revenue cycle leakage rarely is as obvious as a burst pipe. There are tiny, repeatable fractures: a single wrong digit in an insurance ID, a missing modifier, a denial code left uncategorized. 

And like a real leak, you can mop the floor forever, or you can crawl under the sink and tighten what’s loose.  

Our Jan. 6, 2026, MGMA Stat poll found the biggest revenue cycle leaks for practices today are denials and appeals (48%), followed by front end issues (23%), billing/collections (14%), coding (13%), and charge posting (2%). The poll had 288 applicable responses. 

Specifically, you told us: 

• Denials/appeals leakage felt overwhelmingly payer-driven and preventable, centering on medical necessity and non-covered services, bundling/global package edits, utilization management (UM) friction (both in pre-service prior authorization and post-service records requests), eligibility/COB problems, timely filing, and credentialing/CLIA-related denials. Many also pointed to payer errors and policy-change misimplementation, including downcoding and wrongly denied claims that require reprocessing, draining time and revenue. 
  • Related coding contributors included widespread undercoding (especially E/M) driven by limited provider training, missed codes and modifier issues (e.g., Modifier 25), documentation gaps such as insufficient medical-necessity language, and frequent payer-specific rules/edits (including bundling and unit/coding requirements for injectables) that trigger rework and downstream denials. 
• Front end leakage largely comes from eligibility and benefits/coverage accuracy problems — including incorrect insurance entry, outdated demographics, retro terminations, and delays adding newborns — which then cascade into bad estimates and downstream billing/collections issues. The other dominant issues were prior authorizations and referral requirements, compounded by inconsistent copay/point-of-service collection. 
• Billing/collections leakage is being driven by high deductibles and rising patient responsibility, which pushes more balances into post-visit statements and failed payment plans, increasing bad debt — and many practices note they’re still relying on outdated collection methods and need better tools to improve pay-at-check-in and post-insurance follow-through. 
• Other assorted leakage themes included internal follow-up/accountability gaps and delayed charge capture tied to provider documentation and timely charge submission habits. 

Get the help you need 

The 2026 MGMA Financial Conference, March 1–3, 2026, in Phoenix, Arizona, features a range of speakers and sessions to get your revenue cycle management in better shape. 

Denials and appeals: Picking your battles 

A practice's denials queue is like a graveyard of good intentions: You review denials and see the same themes: “medical necessity,” “invalid authorization,” “timely filing,” etc. The team can appeal, but appeals take time, and time is the resource nobody has. You typically lose because you can’t fight back fast enough.  

In 2025, the volume, velocity, and fatigue around this grew. Payer denials felt more automated and less negotiable, with more edits and harder-to-reach payer reps. Even the best care teams aren’t appealing everything — they appeal what matters and work to attack root causes.  

• Learn more: “Denials Management – Innovative Solutions for Medical Practice Administrators – Panel Discussion,” on Monday, March 2, at the Financial Conference will examine strategies and tools for effective denials management, and how to evaluate technology-driven solutions, including automation and analytics. 
• Read more in MGMA Government Affairs’ “The Prior Authorization Landscape in 2025.” 

Front end: A leak you can’t code your way out of 

After months of short staffing, a new scheduler starts her first day juggling hold music, online requests, and an “urgent” add-on. She verifies insurance — sort of. The eligibility tool says “active,” so the appointment is booked. Two weeks later, the patient arrives with a new plan, the deductible reset, and a different payer ID. The visit happens anyway. When the claim goes out, the practice has lost the best moment to collect — when the patient is there, engaged, and expecting a financial conversation. 

The front end feels several pressures: Patient responsibility keeps rising, and the tolerance for surprise balances keeps falling. There’s more pushback at the desk, more payment-plan conversations, and more “I didn’t know” moments. Plus, prior authorization and medical necessity issues creep into these conversations, as well as scheduling scripts and referral workflows. 

To excel in plugging front-end leaks, it often boils down to designing for fewer errors: 

• Build “financial clearance” with eligibility, coverage details, estimated patient responsibility, and auth status (where relevant) before date of service. 
• Pay extra close attention (using checklists and decision trees) for high-denial service lines (imaging, procedures, infusions, DME, etc.). 
• Watch your front-end KPIs [e.g., eligibility error rate, point-of-service (POS) collection rate, and “avoidable reschedules” tied to auth delays]. 

Learn more: “Detecting Revenue Cycle Leaks Before They Drain Your Bottom Line,” 1:15 to 2:15 p.m. MST Monday, March 2, at the MGMA Financial Conference features best-selling MGMA book author Nate Moore, CPA, MBA, FACMPE, in an interactive session on analyzing revenue cycle data sources to detect early indicators of leaks. 

Coding: Where precision pays 

As many practices experienced (or anticipated) more record requests and compliance attention (especially for Medicare Advantage plans), coders were nudged toward safer, more conservative code choices if provider notes were rushed or incomplete. This avoids immediate risk but can leave revenue on the table. 

Medical groups that treat coding and compliance like a team sport — where coders are treated as partners and there is healthy communication with physicians — become better positioned to avoid denials and rework. 

To achieve the goal of faster and safer coding and documentation, many of the solutions are coming from the world of AI: Of the 68% of groups that added or expanded use of AI tools last year, the majority were focused in areas such as ambient documentation, scribing/dictation, provider note-taking, and charting. For practices that have not explored these technologies, earning clinician and coder trust in AI-assisted tools — and vetting vendors like you would any high-impact clinical system — will be a top priority for 2026.  

That means demanding proof a tool performs on your specialties and payer mix (not just generic demos), running a structured pilot with parallel coding and clearly defined success metrics (first-pass acceptance, denial rates by reason, downcoding/upcoding variance, coder productivity without quality loss), and insisting on transparency: audit trails, clear human-in-the-loop workflows, and the ability for coders/clinicians to see why a suggestion was made and override it appropriately.  

Learn more: “Now What? Surviving Coding and Compliance Audits, and Government Investigations,” 2:30 to 3:30 p.m. Monday, March 2, at the Financial Conference, is an interactive session to help leaders be better prepared, with strategic and hands-on guidance, for audits and investigations. 

Billing and collections: When patient-pay becomes the business model 

Your statements are going out on time, but the dollars don’t follow. Patients are paying — just not consistently, and not quickly. Some want digital options. Some want to talk to a human. Some can’t pay the full amount and don’t know how to ask for help. The practice ends up with a growing patient A/R tail. 

Tighter consumer pocketbooks amid inflation contribute to more patient balances aging longer, with practices forced to balance compassion and consistency. Well-designed discount policies, payment plans, and structure to financial assistance are becoming necessary to ensure your staff aren’t improvising. 

As you shift from a culture of sending statements to managing financial engagement with patients, look at segmenting patient balances; small balances shouldn’t get the same workflow as large ones, just as new balances shouldn’t be treated like 120-day balances. Not all dollars cost the same to collect, and not all patients need the same level of outreach to pay. Make it easy to pay in the first seven days: text-to-pay, portal links that work, clearer itemization, fewer handoffs. 

Learn more: “Strategic Revenue Cycle Workplan Design for High-Impact Payer Engagement,” 12:30 to 3:30 p.m. MST Sunday, March 1, at the MGMA Financial Conference is an excellent way to discover real-world examples and actionable tools for healthcare financial leaders. 

Charge posting: A quiet leak that can become a flood 

In an orthopedic group, a provider stays late to squeeze in a patient who “just needs an injection.” The note is signed. The patient leaves happy. The charge? Not so much. It sits in a work queue because the procedure documentation didn’t map cleanly to the charge capture workflow. Nobody notices until month-end, when the billing team is sprinting, clearing edits, and trying to explain why charge lag suddenly spiked. 

The realities of charge posting and charge capture are shaped by speed and complexity colliding: More same-day care, more add-ons, more variability — when schedules are packed and staffing is thin, charge capture becomes vulnerable to “we’ll fix it later.” 

Similarly, EHR and workflow changes can create new failure points. Even small template tweaks can break downstream mapping — and you only find out after the claims are rejected. The lag itself is expensive: Late charges delay cash while compounding rework, raising write-off risk, and inflating A/R days. It might look like a payer problem when it’s actually an internal flow problem. 

Practices may want to explore system-assisted charge capture that prevents leakage upstream. More platforms are integrating real-time prompts and guardrails into documentation so charges are captured correctly at the point of care, with exception-based reviews that target high-risk providers, high-risk procedures, and outlier patterns. 

Learn more: “Agentic AI in Revenue Cycle Management — Driving Accuracy, Efficiency, and Transformation,” 11 a.m. to noon MST Monday, March 2, explores how new tools can reshape your RCM with agentic AI, as well as the governance, workflows and metrics to track ROI. 

Conclusion 

Most practices don’t have one leak — they have a leak that creates downstream leaks. A shaky front end can trigger denials. Late charges can distort A/R and collections. Conservative coding can make your “denials rate” look better while your revenue erodes. Don’t just ask, “Where do we lose money?” Ask where the first drops are hitting the floor.