The healthcare industry is preparing for a significant transformation under the current legislation, which many are calling the Big Beautiful Bill. With sweeping changes to reimbursement models, Medicaid funding, payer oversight, and compliance requirements, revenue cycle management (RCM) teams face a critical moment. Hospitals, physician groups, and health systems must not only adapt to new rules but also rethink how they manage claims, prior authorizations, denials, and patient financial engagement.
1. Medicaid and Coverage Changes
One of the most talked-about impacts of the Big Beautiful Bill is its projected cuts to Medicaid funding. Over the next decade, reductions in federal support could leave millions without insurance coverage. For providers, this likely means higher levels of uncompensated care and more patients entering the system as “self-pay.”
Revenue cycle leaders will need to strengthen financial counseling, charity care programs, and patient engagement strategies to mitigate rising bad debt and ensure that coverage gaps don’t turn into revenue leakage.
2. Reimbursement Pressures
The bill also brings adjustments to Medicare and commercial payer reimbursement. With declining fee schedules and increased scrutiny on medical necessity, healthcare organizations can expect greater pressure to justify services delivered. Value-based care models, tied to patient outcomes instead of volume, are accelerating, demanding accurate data capture, documentation, and reporting.
For RCM leaders, this requires proactive management of coding practices, denial prevention strategies, and payer contract analysis.
3. Prior Authorization and Coding Complexity
Payers are expected to expand prior authorization requirements, particularly for high-cost imaging, specialty drugs, and advanced procedures. These changes often slow down patient access to care while creating administrative bottlenecks for providers.
At the same time, new coding standards such as ICD-11 and evolving CPT/HCPCS codes will add layers of complexity. Revenue cycle teams must stay up to date on coding changes to avoid unnecessary denials and compliance issues.
4. Denials on the Rise
Industry data shows denial rates have been climbing steadily in recent years, and the Big Beautiful Bill is expected to fuel this trend. With payers tightening requirements and regulators enforcing stricter rules, hospitals and clinics can expect more claims to be rejected on the first pass.
This underscores the importance of shifting from reactive denial management (appealing after the fact) to proactive strategies, including predictive analytics, root cause analysis, and smarter workflows to catch issues before submission.
5. Patient Financial Responsibility
As coverage shifts and high-deductible health plans remain common, patients are carrying a larger share of medical costs. This makes patient experience in billing a crucial part of RCM. Transparency, clear cost estimates, digital payment options, and flexible plans are becoming expectations rather than perks. Providers that fail to meet these expectations risk delayed or lost collections.
Looking Ahead
The Big Beautiful Bill will reshape healthcare revenue cycles in 2025 and beyond. While much uncertainty remains, one thing is clear: organizations that adapt early, strengthening their claims processes, coding practices, and patient engagement, will be better positioned to weather the changes.
At Transcend Health Solutions, we’re closely monitoring these developments to support providers navigating the complex world of claims, authorizations, and denials. As the RCM landscape evolves, we stand ready to help healthcare organizations turn challenges into opportunities. Contact us to learn more.