Setting Revenue Cycle Goals for 2026: Why Denied Claims Deserve a Second Look
As hospitals begin setting financial goals for 2026, Revenue Cycle Management (RCM) leaders face familiar challenges: rising denial rates, ongoing staffing constraints, payer complexity, and constant pressure to improve margins without increasing operational costs.
While many revenue cycle strategies focus on front-end improvements and process optimization, one of the most impactful — and often overlooked — opportunities sits further downstream: appealing denied claims.
Financial Goals in 2026 Will Depend on Optimizing Existing Revenue
With patient volumes unpredictable and reimbursement under continued pressure, hospitals are increasingly focused on maximizing the revenue already being generated. For RCM leaders, this means prioritizing:
Net patient revenue improvement
Reduced write-offs
Better recovery on underpaid and denied claims
Stronger cash flow and days in A/R performance
These goals can’t be achieved through prevention alone. Even with best-in-class front-end workflows, denials are inevitable — and in many cases, they are recoverable.
Denied Claims: A Major Revenue Opportunity That Often Goes Untapped
Denied claims represent one of the largest sources of lost revenue in hospital systems. Yet many organizations do not aggressively pursue appeals beyond the first few stages.
Why?
Because appealing denials is often:
Labor-intensive
Time-consuming
Administratively complex
Low on the priority list compared to current A/R
RCM teams are forced to make difficult decisions about where to focus limited resources. As a result, many potentially winnable claims are written off — not because they lack merit, but because the effort required to recover them outweighs available capacity.
Over time, this becomes an accepted cost of doing business, even though it directly undermines financial performance.
Why Denial Appeals Matter More Than Ever in 2026
Payer scrutiny continues to increase, especially for employer-sponsored health plans governed by ERISA. These claims often involve technical appeal requirements, strict timelines, and documentation standards that go beyond typical revenue cycle workflows.
Without specialized focus, these denials frequently fall through the cracks — despite having strong recovery potential.
For revenue cycle leaders setting aggressive financial targets in 2026, ignoring this segment of revenue is no longer sustainable. Appealing denied claims isn’t just a clean-up activity... it’s a strategic revenue lever.
Turning Denial Recovery Into a Sustainable Strategy
Rather than viewing denial appeals as a burden, many hospital systems are beginning to treat them as a structured recovery channel that complements existing revenue cycle operations.
A successful denial recovery strategy:
Targets claims with high likelihood of success
Operates outside already overloaded internal teams
Does not disrupt current RCM vendors or workflows
Produces measurable, incremental revenue
When implemented correctly, denial recovery can provide a meaningful boost to financial performance — without requiring new hires or system changes.
How ERISA Recovery Helps Hospitals Capture Missed Revenue
ERISA Recovery supports hospital systems by identifying and appealing winnable denied claims that are often written off or never fully pursued.
Using advanced technology, we analyze denied claims data to pinpoint recovery opportunities, then manage the entire appeal process on behalf of the hospital — working quietly behind existing teams and vendors.
For Revenue Cycle Management leaders, this means:
No added workload for staff
No disruption to current operations
A new revenue stream generated from existing claims
As hospitals plan for 2026, denial recovery doesn’t have to be another item on an already full to-do list. With the right partner, it becomes an efficient way to help close the gap between financial goals and financial reality.