8 places to look for revenue cycle leaks before they drain your practice

A payer pays your claim, the remittance posts and the money lands in the bank. Case closed, until you notice the code on the 835 isn't the one you sent on the 837. The level five visit you billed came back paid as a level four, and nobody flagged it. Spread that quiet swap across thousands of claims a year and the loss stops looking quiet. In a Jan. 6, 2026, MGMA Stat poll, 48 percent of medical group leaders named denials and appeals their single biggest revenue cycle leak, well ahead of front-end issues at 23 percent.

Much of that leakage is deliberate, Nate Moore, CPA, MBA, FACMPE, told practice leaders during a session on detecting revenue cycle leaks at the 2026 MGMA Summit Digital Conference. Payers run automated software that quietly drops a 99214 to a 99213 or a 99205 to a 99204, said Moore, president of Moore Solutions Inc., then attach a remark code claiming the lower code more accurately describes the visit. He has little patience for that explanation: Payers "wouldn't recognize your patient if they saw them on the street." The swaps rarely announce themselves, surfacing instead as an uncategorized remark code, a contractual write-off a few dollars short or a high-value drug suddenly reimbursed at a fraction of last month's amount.

The encouraging part, Moore said, is that every one of those tactics leaves a trace in the data, and a few targeted dashboards, emails and spreadsheets can surface it before it becomes a flood. He borrowed a line from writer Ryan Holiday to frame the problem as an opportunity: the obstacle is the way to better reimbursement. You don't need to rebuild the billing department to find the money. Here are eight places to start.