December Reset: Strategic Planning for RCM Leaders in 2026

December isn’t just a time to close out the year—it’s your launchpad for the next. For revenue cycle leaders across Texas, this is the moment to move from reactive operations to proactive strategy.

Here’s how high-performing organizations are using December to get ahead.

1. Conduct a Year-in-Review Operational Assessment

Start by asking:

• What KPIs did we meet or miss in 2025?

• Where did denials cost us most?

• How did payer performance shift?

• What staffing trends impacted productivity or morale?

Gather this data by department—Patient Access, HIM, Billing, Collections—and identify top improvement opportunities. Consider involving your CFO, compliance officer, and department managers for a 360° view.

2. Set 2026 RCM Goals with Precision

Set measurable, department-specific goals such as:

• Reduce preventable denials by 15%

• Achieve 95% POS collection rate

• Close accounts within 45 days post-discharge

• Implement real-time eligibility tools in all access points

Align these goals with system-wide financial and compliance priorities. Use data from your year-end review to validate targets.

3. Evaluate Payer and Vendor Partnerships

December is an ideal time to assess:

• Which payers caused the most friction or delays?

• Are your denial management tools effective?

• Is your clearinghouse or statement vendor meeting SLAs?

Schedule contract reviews and performance scorecards before your next renewal cycle.

4. Plan for Workforce Development

With budget resets and performance reviews underway, now is the time to:

• Identify certification or upskilling opportunities (AAHAM CRCS, CRCP, CCT, etc.)

• Launch a front-line mentorship program

• Revisit job descriptions and productivity benchmarks

Leadership training, cross-training, and coaching should be part of your 2026 talent retention strategy.

5. Revisit Compliance Risk Areas

Before audits begin in Q1, evaluate:

• Modifier usage and medical necessity documentation

• High-risk service lines (e.g., behavioral health, telehealth, ED leveling)

• Charge description master (CDM) updates and integrity

Use your internal audit or compliance team to validate and prioritize risk mitigation efforts.

6. Celebrate Wins and Communicate the Vision

Recognize top performers, thank your teams, and clearly share the “why” behind 2026’s strategy. A strong finish helps your team enter the new year with clarity and purpose.

Final Thought: December Is for Strategists

Strong revenue cycle performance doesn’t happen by chance—it’s planned. Use December not just to reconcile numbers, but to design the future of your RCM operations.

Navigating Year-End Challenges: RCM Priorities for Texas Healthcare Leaders

As the fourth quarter accelerates, revenue cycle leaders across Texas face mounting pressures—from hitting end-of-year revenue targets to preparing for 2026 payer contract updates, compliance reviews, and workforce retention. November is a pivotal month, and how we navigate it can make or break financial performance.

1. Reconcile Denials and Aged AR Before the Clock Runs Out

Don’t let old claims follow you into Q1. Focus your teams on:

• High-dollar, aged AR: Prioritize clean-up and root cause analysis.

• Denials by category: Target preventable patterns (e.g., eligibility, authorization).

• Payer-specific escalations: Use Q4 meetings to resolve backlog issues with payers, especially Medicaid MCOs and Medicare Advantage plans.

2. Prep for Payer Fee Schedule and Contract Changes

Texas-based payers often release updates effective January 1. Now’s the time to:

• Review fee schedule adjustments for top commercial payers.

• Conduct impact modeling to assess revenue at risk by CPT and DRG.

• Align with contracting, legal, and revenue integrity to confirm readiness in your CDM and billing systems.

3. Ensure Compliance Readiness Before the New Year

Many hospitals and physician groups will undergo compliance audits early next year. Use November to:

• Review HIPAA, CMS, and OIG requirements.

• Audit high-risk billing areas (e.g., observation, modifiers, telehealth).

• Ensure CCT training is completed if you leverage it for CMS or TJC compliance.

4. Re-Engage Your Front-End Teams

Q4 burnout is real, especially in patient access. Reinforce:

• Insurance verification and authorization accuracy

• POS collections coaching

• Recognition efforts to boost morale during peak holiday staffing challenges.

5. Close the Books with Integrity

Work closely with finance on:

• Contractual allowances and bad debt reserves

• Final cash posting and adjustment accuracy

• Reconciling payer withhold or risk-sharing payments

Final Thought: November Is for Leadership

This is not the time to just "get through" the year. Texas RCM leaders have an opportunity to lead intentionally, close the year strong, and lay the groundwork for strategic innovation in 2026.

Let’s model the kind of leadership our teams—and our industry—need right now.