By Jill Arena & Taya Gordon
This year’s MGMA Financial and Operations Conference (FinCon) delivered exactly what healthcare finance leaders and physician executives need right now: clarity. As margins tighten, payer behavior evolves, and operational complexity grows, the conversation has shifted from theory to execution.
Presentations and discussions with peers from across the country pointed to three recurring priorities: strategic revenue cycle planning, payer downcoding trends, and more effective contracting strategies for medical groups. Each of these areas reinforces a core belief we’ve long held at Health e Practices: healthy practices don’t happen by accident; they are intentionally designed.
- Strategic Revenue Cycle Plans Are No Longer Optional
One of the most consistent messages at FinCon this year was this: reactive revenue cycle management is no longer sustainable.
Medical groups that are still operating in a “fix it after the denial” mindset are falling behind. The leading organizations are building strategic, forward-looking revenue cycle plans that integrate operations, finance, and clinical documentation.
This means:
- Proactively identifying revenue leakage points
- Aligning coding, documentation, and compliance workflows
- Investing in data visibility and KPI-driven decision-making
We heard multiple case studies where groups increased net collections not by working harder but by working smarter. A well-designed revenue cycle isn’t just about billing; it’s about system architecture.
This aligns deeply with our own philosophy: physicians are often asked to run multi-million-dollar businesses without formal training in these systems. That’s not a personal failing; it’s a design gap we can fix.
- Downcoding by Payers: The Quiet Margin Erosion
If there was one topic that sparked both frustration and urgency, it was payer downcoding.
Across specialties and locations, practices are seeing a rise in claims being systematically reduced and often without clear justification. The financial impact is significant, but the operational burden is just as concerning.
The key takeaway? Most organizations are underestimating how much revenue they’re losing.
Leading groups shared a more disciplined approach:
- Routine auditing of paid claims vs. submitted codes
- Clear escalation pathways for payer disputes
- Dedicated resources (internal or outsourced) for follow-up
Perhaps most importantly, there was a mindset shift. Instead of viewing downcoding as “the cost of doing business,” top-performing groups are treating it as a correctable system issue.
This is where education and structure matter. When physicians and administrators understand what “right” looks like in coding and reimbursement, they can advocate more effectively and recover meaningful revenue.
- Contracting Strategies Are Becoming a Competitive Advantage
Another standout theme was the growing sophistication around payer contracting.
Historically, many medical groups approached contracts passively accepting terms with minimal negotiation or ongoing analysis. That approach is quickly becoming obsolete.
We saw a different model emerging at FinCon:
- Regular contract performance reviews tied to actual reimbursement data
- Strategic renegotiation cycles based on leverage and market positioning
- Alignment between contracting terms and operational capabilities
In other words, contracts are no longer static documents but dynamic tools.
One particularly compelling insight: groups that understand their data, including true cost per visit, payer mix performance, and denial trends, are negotiating from a position of strength. Those that don’t are leaving money on the table.
This is where experienced guidance can make a measurable difference. Knowing what to ask for, when to push, and how to structure agreements is both an art and a science.
Final Thoughts: Systems Drive Outcomes
If there’s a unifying thread across all these conversations, it’s this: better systems lead to better outcomes for physicians, teams, and ultimately patients.
This year’s FinCon reinforced that the future of healthcare finance belongs to organizations that are:
- Proactive instead of reactive
- Data-driven instead of assumption-driven
- Strategically aligned instead of siloed
As always, our guiding question remains: What can we do today that creates a better future?
For physician leaders and administrators, that starts with understanding your numbers, strengthening your systems, and surrounding yourself with the right expertise.
We’ll be exploring each of these topics in more depth on upcoming episodes of the Medical Money Matters podcast by breaking down complex issues into practical, actionable insights.
Together, these trends point to a more disciplined, data-driven approach to financial performance. This is the work we focus on every day at Health e Practices, helping medical groups improve revenue cycle performance, respond to payer trends, and strengthen contracts. If any of these areas are a priority for your organization, we’d welcome the conversation, contact us here.