How Shifting Payer Behavior Is Reshaping Reimbursement Risk
Sift Healthcare has released its fourth annual Denials Insights Report, based on denial and adjudication patterns observed across 2025.
The primary lesson: payer behavior continued to shift in ways that extend beyond what most revenue cycle reporting frameworks track. Health systems typically measure denial risk through CARC codes and remittance files, but payers increasingly operate outside that structure.
Some of the key themes Sift is tracking into 2026:
- Medical necessity denials that never receive a CARC and never surface in the 835
- Inpatient stays “approved” but reimbursed at observation rates
- Bundling and non-covered codes masking reimbursement shortfalls
- Itemized bill requests functioning as cash-flow delays
- Post-payment takebacks arriving months after discharge
In each case, revenue loss is real but not always labeled as a denial. When reporting infrastructure remains static, and payer tactics evolve, the gap becomes measurable in margin, not metrics.
This year’s report outlines where that gap is forming and what revenue cycle leaders should be watching as they plan for 2026.
Download the full Denials Insights Report here: https://www.sifthealthcare.com/denial-insights
