Revenue Recovery Urgency in the OBBBA Era | FinThrive

Opportunity Costs in Failing to Capture Lost Healthcare Revenue During a Federal Coverage Contraction

While caution in times of uncertainty may be prudent, complacency as a healthcare organization can have severe consequences.

The One Big Beautiful Bill Act (OBBBA), signed into law in July 2025, has fundamentally altered the healthcare landscape. By introducing almost $1 trillion in reductions to federal healthcare support—including Medicaid, ACA Marketplaces and Medicare—OBBBA threatens the coverage of millions of patients and creates new operational and financial risks for providers.

Hospitals and health systems face huge opportunity costs if they let these policy changes interrupt revenue cycle initiatives. Simply staying afloat by keeping essential IT, tactical and staffing projects in a holding pattern is no longer sufficient. Providers that choose to remain static and wait out the storm will risk significant revenue losses, weaken their financial positions and face compliance risks and penalties under new mandates and audit regimes.

Where Hospitals Are Feeling the Impacts of OBBBA

The following impacts represent some of the challenges providers are dealing with now and in the near future:

• Coverage Losses and Payer-Mix Deterioration:
  OBBBA’s Medicaid financing restrictions, work requirements and tighter eligibility verification are projected to result in 9–15 million more uninsured Americans by 2034. This will shift volume to uncompensated care and bad debt, increasing financial pressure on hospitals.
• Marketplace Friction and Subsidy Retrenchment:
  The reduction of enhanced premium tax credits, state directed payments and new pre-enrollment verification requirements will push some patients off subsidized coverage, increasing renewal failure risk and administrative burden.
• Operational Strain—Rural and Service-Line Risk:
  Rural systems are already making tough decisions such as closing service lines as administrators anticipate leaner federal flows and rising uncompensated care. These dynamics exacerbate staffing gaps and jeopardize access in vulnerable communities.
• Systemic Reimbursement Compression:
  Advisory Board estimates indicate $910B in reimbursement reductions over 10 years when Medicaid and sequestration effects are combined—tightening margins precisely as eligibility verification hurdles increase denials risk.

Bottom line: OBBBA isn’t a transient demand shock; it’s a structural policy shift that will permanently alter payer mix, eligibility friction and net reimbursement risk across the next decade.

Find a Way Forward or Fall Further Behind

In the face of these challenges, caution may not represent the best strategy for revenue recovery, as there are simply too many dollars at risk. The cost of waiting is twofold:

1. Eligibility and timely filing windows will be missed amid increased administrative friction.

2. Backlogs compound just as payer scrutiny and audit intensity rise.

A recent FinThrive study of customer data shows that a typical single-facility hospital could stand to lose over $581K in average annual revenue recoveries if it fails to act within 180 days on identified revenue opportunities such as insurance discovery, Medicare bad debt, Transfer DRG and Disproportionate Share Hospital (DSH). 

In a multi-facility health system with five hospitals, unrecoverable losses can exceed $2.9M annually. When organizations miss deadlines or are unable to reopen a cost report retrospectively, these revenues are lost forever.

Table 1: FinThrive Recoveries Across Base of Client Hospitals (on Average) – OBBBA Era

INS DIS = Insurance Discovery, MCBD = Medicare Beneficiary Bad Debt, TDRG = Transfer DRG recoveries, DSH = Disproportionate Share Hospital recoveries

How to Move Forward with Confidence Under OBBBA

Organizations need to act now and step up to the challenge to capture lost revenue amidst the distractions of OBBBA. By ramping up revenue recovery efforts, adding users to insurance discovery platforms and increasing staffing, FinThrive customers have seen dramatic increases in monthly recoveries and reductions in account backlogs.

Increasing spending on technology and services may be challenging, but the expense is justified by the offsetting benefits of significant revenue and improved financial stability.

Revenue Recovery Strategies and Enabling Capabilities

Don’t let OBBBA-era challenges erode your margins. Discover how FinThrive’s Revenue Recovery solutions can help you capture lost revenue and strengthen financial resilience.

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