If your Q2 collections are down, you may be looking for one cause. But there are three. They run at the same time, hit different payers, and each needs a different fix. Practices without the right healthcare payment solutions in place are often the last to see the full picture.

CMS removed geographic limits on behavioral health telehealth in 2026. That change is a major win for outpatient mental health practices. But permanent access does not fix your billing. Four common gaps still cost practices $35-$60 per visit. These errors do not always create clear claim rejections. If your team still uses a generic telehealth billing workflow, those losses keep adding up across your whole patient panel. 

Case volumes are up. The rooms are full. The schedule is packed.

And yet, margins are shrinking.

That is the story heading into the 2026 ASCA Conference. Growth is real. But four cost pressures are hitting at the same time:

If you run a 5 to 20 physician group and are not thinking about a sale, your billing setup probably feels like an ops problem — not a strategic one. That view costs practices real money when a deal process starts. As MSMS advisory guidance from April 2026 notes, billing gaps and charge capture issues have shaped more than 40% of provider-side M&A deals. This leads to lower valuations, re-negotiations, or deals that fall apart.

Prior authorization is one of the biggest time drains in specialty care, and if you work in dermatology, oncology, or rheumatology, you already know the cost. You submit a PA. You wait. You resubmit. You wait again. Your staff spends hours on hold. Your patients wait longer for care. And your revenue cycle management slows down.

You get a denial from a Medicare Advantage (MA) plan. Your staff takes one look, then redirects their focus to the next item in line. The denied claim sits in a queue. Then it ages out.

Your original Medicare billing rules changed on January 1, 2026. If your practice is in Arizona, New Jersey, Ohio, Oklahoma, Texas, or Washington, this affects you now. The CMS WISeR pilot requires prior authorization for 17 outpatient procedure categories. Claims without PA are being denied.

United Healthcare made a big move on April 20, 2026. It announced it will remove most prior auth (PA) requirements for about 1,500 rural hospitals. That includes all Critical Access Hospitals. It also cut payment timelines from 30 days to under 15 days on average. For rural revenue cycle teams, this is real relief.

CMS continues to refine how payments differ by care setting in 2026, making site-of-service accuracy more financially impactful than before.

A new medical device gets FDA approval. Your doctors want to use it. The clinical case is strong. But Medicare will not cover it yet. So, you wait. Sometimes 12 months, sometimes 18 months, and sometimes longer.