RCM pressure rises
Radiology revenue cycle leaders are warning of rising pressures in Q2 from Medicare updates and expanded prior authorization, and vendors are promoting automation and patient‑intelligence tools as mitigation. Industry commentary is urging practices to monitor denial trends and invest selectively in lean RCM processes to protect cashflow. (x.com 1) (x.com 2)
A radiology group can do the scan, send the bill, and still wait months to get paid if one code is priced differently by Medicare or one authorization is missing from the chart. That squeeze is getting sharper in 2026 because Medicare changed physician payment rates on January 1 and the Centers for Medicare and Medicaid Services is also expanding prior-authorization workflows for some services. (cms.gov 1) (cms.gov 2) The payment side starts with the Medicare Physician Fee Schedule, which is the price list Medicare uses for doctor work and many imaging services. In 2026, Medicare moved to two conversion factors, with $33.4009 for most clinicians and $33.5675 for qualifying alternative payment model participants, and radiology groups have been recalculating code-by-code impacts ever since. (cms.gov) (acr.org) That sounds abstract until it hits a practice’s daily cash register. Radiology bills thousands of individual procedure codes, and the American College of Radiology published 2025-to-2026 impact tables precisely because even small reimbursement changes can add up fast across high-volume magnetic resonance imaging, computed tomography, ultrasound, and interventional work. (acr.org) The second pressure point is prior authorization, which is the insurer asking for permission before a service happens. In radiology, that step works like a gate in front of the scanner: if the approval is late, incomplete, or denied, the exam may be delayed or the claim may bounce back later. (cms.gov) Medicare’s newest test here is the Wasteful and Inappropriate Services Reduction model, a six-year program that began January 1, 2026 in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. The model uses technology-enabled prior authorization for 11 services in year one, including several interventional procedures that touch radiology workflow. (acr.org) The American College of Radiology said last July that the model would cover services such as percutaneous vertebral augmentation, epidural steroid injections, and percutaneous image-guided lumbar decompression. It also warned that if a provider skips the advance process, the claim can be flagged for prepayment review by the Medicare Administrative Contractor instead. (acr.org) Even now, the rules are still moving under operators’ feet. On April 6, 2026, Medicare delayed implementation for two WISeR services, including percutaneous image-guided lumbar decompression for spinal stenosis, because of “operational readiness,” which shows how quickly scheduling, coding, and collections teams may need to adjust. (federalregister.gov) At the same time, Medicare is pushing the industry toward electronic prior authorization. The Interoperability and Prior Authorization Final Rule was released on January 17, 2024, required certain provisions by January 1, 2026, and gives most impacted payers until January 1, 2027 for the application programming interface pieces, so 2026 is a transition year where old fax-era habits and new digital workflows are colliding. (cms.gov) That is why vendors are selling automation so aggressively right now. If a software tool can catch a missing authorization, route a chart to the right work queue, or spot a denial pattern before month-end, it can protect cash flow the same way a leak sensor protects a basement before the water reaches the floorboards. (cms.gov 1) (cms.gov 2) The catch is that software does not repeal Medicare rules or payer edits. What it can do is shorten the time between a policy change and a practice response, which is why radiology business offices are being pushed to watch denial codes, authorization turnaround times, and days in accounts receivable much more closely in the second quarter of 2026. (cms.gov) (federalregister.gov) The result is a very specific kind of pressure on radiology groups. The scanner may be full, the radiologists may be reading at normal pace, and patient demand may still be there, but one payment update and one extra authorization checkpoint can turn a busy imaging center into a slower cash machine. (cms.gov) (acr.org)
