A growing disconnect between payers and providers is making it harder than ever for healthcare organizations to get paid. According to a new report from Guidehouse and the Healthcare Financial Management Association, 88% of providers say disagreements over claims are preventing timely and full reimbursement, while denial rates, prior authorization delays, and unclear payer responses continue to climb.
Payer Friction Is the Core Issue
The tension between payers and providers continues to dominate revenue cycle challenges. The report highlights several key shifts in payer behavior:
- 81% of providers report an increase in denials
- 74% cite more prior authorization delays
- 73% point to vague denial reasons or underpayments
- 69% say excessive information requests are slowing payments
- 41% report reduced reimbursement rates
One-fifth of providers now report denial rates above 5%, nearly doubling from the prior year.
The rise in denials and delays is making it increasingly difficult for providers to forecast revenue and maintain steady cash flow. As noted in the report, payer-provider friction remains the top stressor for healthcare finance leaders, with nearly nine out of ten executives ranking it among their biggest concerns.
To cope with staffing shortages and complexity, providers are increasingly turning to third parties:
- 66% are outsourcing all or part of their revenue cycle
- The most common areas include accounts receivable follow-up, collections, and denial management
This trend presents a clear opportunity for companies that can help providers improve recovery rates, accelerate payments, and navigate payer challenges more effectively.
The report frames the current moment as a “tug-of-war” between payers and providers — one that is unlikely to ease without better alignment, transparency, and governance.
