The Revenue Leakage Crisis Reshaping Healthcare in 2026

Earlier this year at Nextech EDGE 2026, I had the opportunity to sit on a panel alongside several leaders deeply embedded in the realities of revenue cycle performance. These were not theoretical conversations. Each of us brought a perspective shaped by what we see inside organizations every day.

During the discussion, a question came up that shifted the tone entirely and has resonated with me ever since.

Where is revenue being lost today?

Not delayed. Not sitting in A/R. Lost.

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As we worked through that question, it became clear that while everyone had examples, very few organizations have a clean, connected answer. We talked through rising denial rates, underpayments that are never fully recovered, missed charges, and authorization gaps that impact reimbursement before a claim is even submitted.

None of this was new. What stood out was how often these issues are treated separately, when in reality they point to a much larger, systemic problem.

That discussion made one thing clear. We are still looking at the revenue cycle in pieces instead of seeing the full picture.

We Are Measuring the Outcome, Not the Loss

Most organizations remain anchored to downstream performance metrics. Days in A/R, net collection rate, and cash posted remain the standard indicators of success. These metrics matter, but they only tell part of the story.

They reflect what happened after revenue has already moved through the system, not where it may have broken down along the way.

By the time those numbers shift, the opportunity to fully recover that revenue has often passed.

A denial is rarely just a billing issue. It is typically tied to something upstream:

• Incomplete documentation
• Missed or incomplete authorizations
• Disconnects between clinical intent and coding

The same pattern applies to underpayments and missed charges. These are not isolated errors. They are downstream symptoms of upstream gaps.

In many organizations, these issues translate into 3%-7% of net patient revenue that is never collected — not delayed, but permanently lost.

Where Revenue Is Actually Lost

Revenue loss begins at the front end, where it is also most preventable. Errors in eligibility and demographics, missing authorizations, intake mistakes, and weak time-of-service collections create issues before a claim is ever submitted. That sets the stage for downstream inefficiencies. In the mid-cycle, more subtle operational gaps, such as poor documentation, coding errors, and missed charges, can quietly erode reimbursement or prevent services from being billed altogether.

By the back end, these problems become far more visible, and significantly harder to recover. Denials, underpayments, downcoding, and write-offs tied to bad debt, authorization gaps, medical necessity, or bundling all contribute to lost revenue that demands substantial effort to recapture. With roughly 15% of claims denied on first submission – and each denial costing $25-$30 to rework – many organizations find themselves expending disproportionate resources chasing revenue they have already earned, often with diminishing returns.

Small Gaps, Real Financial Impact

Revenue leakage is rarely caused by one major failure. It builds through small, consistent breakdowns in process, communication, and execution.

Individually, these gaps may seem manageable. Together, they create meaningful financial impact that is often underestimated or missed entirely.

A documentation gap may not appear until a payer audit. An authorization issue may not become visible until reimbursement is limited or denied. A coding miss may only be identified after the claim is processed. By then, the effort to correct it is higher, and the likelihood of full recovery is lower.

For many practices, even a 3%-5% leakage rate can mean the difference between operating comfortably and constantly playing catch-up.

Revenue Leakage Is a Life Cycle Problem

Revenue is at risk across the entire life cycle, not just at billing or collections. It starts earlier than most teams realize, often in areas not traditionally viewed as revenue cycle functions. Clinical documentation, authorization workflows, intake processes, and coding accuracy all play a role in whether revenue is captured correctly the first time.

When those elements are not aligned, the impact compounds. A gap at the front end creates rework at the back end. By the time these issues appear in the A/R, they are harder to fix and less likely to be fully recovered.

What makes this more challenging is visibility. Data is fragmented across systems, teams operate in silos, and reporting focuses on outcomes rather than root cause.

Organizations can see performance slipping, but not always where or why revenue is being lost.

A Shift in Perspective

The organizations that are performing differently are asking a more direct question: Where is revenue at risk before it ever has a chance to be collected?

Because the reality is this: Most organizations are not losing revenue at the end of the cycle. They are losing it all the way through it.

Revenue leakage is not just a billing problem. It is a life cycle problem, and organizations that continue to treat it as a back-end issue will keep chasing revenue that was never collectible to begin with.

This blog post is part of a series on revenue cycle management produced in partnership with Assembly Health.

About the Author

Samantha Akhtarzandi is the Executive Vice President of Growth, Physician Revenue Cycle Management at Assembly Health. In this role, she leads strategic growth initiatives, supports enterprise sales, manages key client relationships, and serves as a trusted advisor to healthcare organizations seeking to optimize financial performance and operational efficiency across the revenue cycle.

Prior to joining Assembly Health, Samantha was the Founder and CEO of Doctors’ Choice Medical Services, where she successfully built and scaled a high-performing RCM organization. Samantha is known for her strategic insight, client-centric approach, and ability to translate complex revenue cycle challenges into actionable solutions that drive growth and long-term value.