Payer demands push most groups toward revenue cycle automation, starting with the EHR

Nearly two-thirds of medical groups are leaning harder on revenue cycle automation this year as payers pile on prior authorizations, denials and downcodes.

In an Oct. 20 MGMA Stat poll, 63 percent of 214 respondents said their organizations are moving toward more automation in 2026, according to MGMA's write-up of the results. Another 26 percent expected no major change, and 11 percent said they were shifting toward more manual work.

Coding topped the list of tasks groups are automating, followed by prior authorization, denials and appeals, and payment posting. Claim submission, patient billing, eligibility verification and scheduling came up less often. MGMA did not publish percentages for individual tasks.

The pressure is coming from payers. MGMA notes that 90 percent of practices in its 2026 Regulatory Burden Report said their prior authorization burden grew over the previous 12 months, and automatic downcoding by Medicare Advantage plans is now the fastest-growing complaint it hears from members. Shawntea "Taya" Gordon, MBA, FACMPE, an MGMA consultant and CEO of Atlas & Perpetua Healthcare Consulting, told Physicians Practice that payers now review and deny claims faster than most practices can appeal them by hand.

The EHR is where the work starts

For many groups, the automation decision runs straight through the EHR. One poll respondent summed up the organization's change as a switch to Epic. Another described an EHR with so many workarounds that staff still have to step in manually.

Julia Rosen, MGMA's senior vice president of IT, told Medical Economics that practices should look first at the AI tools already built into their EHR before taking on the licensing fees and implementation work of standalone products. She recommended starting in revenue cycle, for example by running remittance files through a HIPAA-compliant AI tool to find the root causes of denials, because the payback tends to come quickly.

Working inside the EHR also sidesteps a problem former CMS Administrator Seema Verma, now an Oracle Health executive, flagged at the MGMA 2026 Annual Conference: bolting on one AI tool for the billing team and another for physician coding without a plan for how they share data, as Physicians Practice reported.

The next payer-driven deadline runs through the EHR, too. Under the CMS Interoperability and Prior Authorization final rule, covered payers generally must have prior authorization APIs in production starting Jan. 1, 2027. MGMA's Anders Gilberg said few members MGMA staff asked at the conference had heard from their EHR vendors about it. MGMA suggests practices press their EHR and practice management vendors this quarter on which payers' prior authorization APIs will connect to their system, when and at what cost.

Fix the process, then automate it

New software will not rescue a broken workflow. Shannon Cameron, COO of revenue cycle at Harvard Medical Faculty Physicians in Boston, told Becker's Hospital Review that automating a flawed process simply repeats the same mistake faster, across thousands of claims.

Staffing is part of the math. Kem Tolliver, president and CEO of Medical Revenue Cycle Specialists, said in a recent Physicians Practice short that outdated technology and repetitive manual work drive billers out, and better tools would keep them longer. Among the 11 percent of poll respondents moving toward more manual work, the reasons included payer complexity, tool gaps and staffing problems.

For administrators weighing the next purchase, the order of operations is clear: map the payer-driven work, check what the EHR already does and get an answer from the vendor on the Jan. 1 API deadline before buying anything new.