HFMA Annual 2026: What I Heard, What It Confirmed, and What Comes Next

By Noah Breslow, CEO at Revecore

A few weeks out from HFMA Annual, I’m still fielding calls that trace back to a conversation in the Revecore suite or on the sidelines of a session, and those follow-ups have only sharpened what I took away. A few themes carried more urgency than most this year. These are the ones that keep coming up. 

The numbers are getting harder to ignore. 

Medicaid cuts, ACA subsidy expirations, and shifting coverage mix dominated more conversations than almost anything else. Leaders are working through scenarios that would have seemed far-fetched two years ago, and the uncompensated-care numbers are getting worse faster than most projections accounted for. 

The denial numbers made that urgency concrete. Every tracked denial metric rose year over year. Clinical denials were up 8.3%. Medicare Advantage denials are occurring at three times the rate of traditional Medicare. That reflects a deliberate shift in how payers are managing their own cost pressure, and providers are the ones absorbing it. 

The leaders I spoke with were not panicking, but they were serious. The conversation has moved from “how do we handle this quarter’s denial volume” to “how do we build infrastructure that handles sustained payer pressure without depending on heroics from our staff.” 

AI is everywhere. Confidence is earned slowly. 

The phrase I heard more than any other was “battle of the bots.” Payers are using automation to deny faster while providers are deploying automation to respond faster. The people responsible for results are stuck in the middle trying to figure out which tools are producing outcomes and which are just producing activity. 

The systems making meaningful progress started narrow: defined use cases, short feedback loops, a clear way to know when the model is wrong. They built confidence before expanding scope. Uncritical enthusiasm was in short supply. The request that came up most often: show me what it’s doing and show me how you’ll know when it’s wrong. 

That’s the bar we’re working to clear at Revecore. We’re building AI into workflows that already carry deep clinical and operational logic behind them, developed across 750 million+ claims and counting. While others look to replace that judgment, Revecore’s goal is to scale it.  

There’s no substitute for thoughtful leadership. 

The highlight of the week for me was my session with Harold Mueller, Chief Revenue Officer at BJC Health. Harold has spent seven years building a true Revenue Integrity Operating Model across 24 hospitals: centralized governance, standardized workflows, embedded revenue cycle liaisons in each facility, and a tiered huddle structure that surfaces problems at the front line rather than after month-end close. They reduced avoidable write-offs by nearly $9 million in the first year of their denial prevention task force and are tracking toward another $15-$20 million reduction in 2026. 

One key moment stayed with me. Harold reinforced his view that the technology is a tool, but the operating model is the foundation. You can buy analytics and deploy automation, but if governance is not right and accountability is not defined across clinical, operational, and financial teams, the tools do not hold. 

A lot of conference conversation defaults to which AI platform a system is running. Harold’s work is a reminder that organizational design still does most of the heavy lifting. 

(We also had the experience of speaking immediately after Dr. Mehmet Oz, Administrator of CMS. I am told we held a respectable portion of the audience. I’ll take it!) 

What leaders are looking for right now 

Across two receptions in the Revecore suite with our friends at J.P. Morgan Healthcare Payments and RevHC, and meetings throughout the week, a few themes kept coming up about what health systems want from external partners right now. 

• Fewer vendor relationships with deeper accountability. Leaders want partners embedded in their operating model who can identify why something is happening and address it upstream, not drop a report after the fact. 

• Visibility into what is being worked. What claims are in flight? What’s the trend over the last 90 days? Basic questions that are consistently hard to answer when reporting is built to look pretty rather than to inform. 

• Payer-specific depth. Underpayments, third-party liability, workers’ comp, Medicare Advantage adjudication. The claim types driving the most write-offs tend to require the most specialized knowledge, and that’s where generalist platforms run thin. 

One theme I expect to hear more of is centered around patient financial experience as a brand issue. Leaders are watching patients choose providers based in part on how a prior billing experience went. The connection between financial communication and patient loyalty is more direct than most RCM conversations acknowledge. The differentiators are what they have always been. Leadership clarity, organizational discipline, and the right external support in the right places set the leader apart. The pressure is higher now and the tolerance for imprecision is lower. 

What gave me confidence walking away was the quality of the people working through it. Revenue cycle leaders are not standing still waiting for payer behavior to reverse or policy uncertainty to resolve itself. They are building better infrastructure, asking harder questions, and holding their partners to a higher standard. That is the right response to a hard moment. I’m looking forward to what we build together before we’re all back in Denver next year.