How Hospital RCM Teams Can Offset Rising Uncompensated Care in 2026
As uncompensated care continues to climb heading into 2026, hospital RCM teams are turning to insurance discovery as a critical defense against preventable revenue loss and misclassified self-pay accounts.
Common sources of uncompensated care include:
- Medicaid disenrollments and coverage volatility
- Rising deductibles and patient financial burden
- Tightening payer policy
- New regulatory expectations under The One Big Beautiful Bill Act
These pressures are converging in 2026, and RCM teams can expect to feel them operationally. This combination of factors will likely lead to more self-pay, more denials and more downstream rework.
The One Big Beautiful Bill Act (OBBBA), especially, is expected to be a significant driver of uncompensated care in 2026 as hospitals begin to implement its provisions. The bill, signed into law in July 2025, is intended to increase billing transparency and simplicity. But new rules around reporting, work requirements and other minutiae are expected to cause millions of procedural disenrollments.
In the face of these challenges, hospitals must find all available coverage before classifying an account as self-pay. The easiest and most impactful way to address uncompensated care is through insurance discovery.
Insurance discovery identifies billable coverage patients may not know they have, to reduce the misclassification of self-pay accounts. It’s essential for early revenue recovery before bad debt accrues.
Sources of Uncompensated Care Hospitals Can Prevent
Not all uncompensated care is preventable. But many of the largest revenue losses hospitals experience can be avoided with tools like insurance discovery. Common preventable drivers include:
- Incorrect or missing insurance coverage: A self-pay misclassification can result from failure to identify accurate Medicaid, commercial, exchange or secondary coverage. Patients may also be unaware of existing benefits or unwilling to disclose.
- Coordination of benefits inaccuracies: Billing the wrong payer in the wrong order remains one of the most reliable paths to denial. Incomplete COB visibility creates avoidable write-offs even when coverage exists.
- Static eligibility workflows: Eligibility treated as a one-time checkpoint fails in an environment of constant coverage change. As payer rules, patient circumstances, and enrollment status shift, outdated eligibility data becomes a primary source of uncompensated care.
Why Legacy RCM Workflows Are Breaking Down
Traditional RCM environments were not designed for today’s level of coverage volatility.
Fragmented systems, manual verification processes and point-in-time eligibility checks create blind spots that force staff into reactive cleanup mode. Accounts are often routed to self-pay based on incomplete information, not because coverage truly does not exist.
The downstream consequences are familiar to most revenue cycle leaders:
- Increased denials tied to eligibility and COB
- Delayed cash flow and rising AR
Staff burnout from repetitive manual correction - Opportunity cost as teams spend time fixing preventable errors instead of optimizing revenue
Without modernization, these issues scale alongside patient volume and regulatory complexity, making uncompensated care increasingly difficult to contain.
Insurance Discovery Helps Prevent Bad Debt
For hospital RCM leaders, insurance discovery should not be viewed as a niche recovery tactic or a last-ditch cleanup effort. When deployed strategically, it functions as a high-ROI control mechanism that protects revenue integrity across the patient lifecycle.
This tool can be used at multiple points throughout the patient journey to mitigate uncompensated care risk. Instead of a one-time fix, think of insurance discovery more like an ongoing safeguard.
While insurance discovery delivers clear value as a revenue recovery tool, its impact increases significantly when it is embedded earlier and more broadly. Used strategically, it supports three critical objectives:
- Reducing premature self-pay classification
- Improving payer sequencing accuracy
- Recovering revenue before accounts age into bad debt
Where Insurance Discovery Can Create the Most Value
Insurance discovery delivers the greatest impact when aligned with key operational moments:
Pre-service
Validates primary, secondary, and tertiary coverage beyond what patients self-report—reducing downstream eligibility surprises.
Post-discharge
Identifies overlooked coverage on accounts already routed to self-pay, converting lost revenue into recoverable reimbursement.
Periods of coverage churn
During Medicaid redeterminations or regulatory transitions, continuous monitoring helps identify coverage that becomes active again or was never truly inactive—allowing faster correction before write-off.
Used this way, discovery shifts revenue recovery earlier in the lifecycle, where effort is lower and returns are higher.
How Office Ally Can Help Offset Uncompensated Care in 2026
Office Ally enables hospitals to operationalize insurance discovery as part of a broader revenue integrity framework, rather than treating it as a standalone tool.
Insurance Discovery
Insurance Discovery identifies active, billable Medicare, Medicaid and commercial claims coverage on accounts classified as self-pay. With one of the largest eligibility verification footprints in the U.S., Office Ally processes hundreds of millions of transactions annually to uncover coverage that would otherwise go unbilled.
Inaccurate patient insurance coverage is one of the top reasons that claims are denied or rejected. Our proprietary algorithms and extensive experience identify valid and billable insurance coverage that had been classified as self-pay, financial assistance, or bad debt.
In action: One health system on the East Coast conducted a comprehensive review of over 87,000 of the facility’s self-pay accounts, going back 1 year, using Office Ally’s Insurance Discovery. The final report found 21.2% of the 87,000 accounts already checked and classified as self-pay had active, billable coverage that had been overlooked. In total, Insurance Discovery helped recouped $3.14 million in payments for the health system.
Verify360
Verify360 extends eligibility beyond a single checkpoint. When coverage appears inactive or unknown, eligibility verification automatically cascades into insurance discovery, ensuring that no billable coverage is missed upfront.
By continuously identifying primary, secondary, and tertiary payers, Verify360 reduces COB-related denials and supports cleaner claims submission during periods of high coverage volatility.
Together, these solutions help hospitals move from reactive eligibility cleanup to proactive revenue protection. With both Insurance Discovery and Verify360, automated workflows reduce manual labor and increase staff efficiency. Staff can focus on claims that require human intervention rather than cleaning up eligibility issues that could have been caught earlier. As the cherry on top, revenue cycle teams can expect faster reimbursement through clean, accurate claim submission—the first time.
The 2026 Roadmap for RCM Teams
In 2026, verifying coverage before every encounter is more important than ever. Hospitals are coming off the end of Medicaid redetermination from the end of the COVID-19 public health emergency and moving straight into massive expected disenrollment from OBBBA. In between, the usual culprits are human error, tightening payer policy and rising patient deductibles.
- Coverage verification treated as a continuous process, not a front-end task
- Regular audits of self-pay accounts to validate classification accuracy
- Automated discovery and monitoring to reduce reliance on manual correction
- Clear accountability for eligibility accuracy and payer sequencing
Taking Control of Uncompensated Care in 2026
Rising uncompensated care may feel inevitable, but significant portions of it remain preventable. With the right technology and workflow design, hospitals can protect revenue without increasing staff burden.
Office Ally provides a practical starting point for health systems looking to evaluate how effectively their current workflows are identifying and billing all available coverage. Even organizations with insurance discovery in place may benefit from an objective assessment of performance, coverage yield, and self-pay accuracy.
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OA Editorial Team
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