2026 Reimbursement Reset: A Framework for First-Pass Payments-[Replay] 2026 Reimbursement Reset: A Framework for First-Pass Payments

Video Transcription

Video Summary

The AAOE webinar, presented by Bronson Cox, COO and Co-Founder of Encoda, focused on understanding and improving the "2026 Reimbursement Reset" with an emphasis on first pass payment rates in medical practices. Key points included distinguishing between clean claim rate and first pass payment rate. While many practices boast high clean claim rates (claims accepted into adjudication), this does not guarantee low denial rates or timely payments. Cox emphasized that clean claim rates reflect claims not rejected before adjudication, but payment depends on successful processing post-adjudication, which often includes denials unrelated to rejections. The webinar discussed the claim adjudication pipeline and the importance of analyzing data beyond simple clean claim metrics. Cox encouraged practices to shift focus toward first pass payment rates—the percentage of claims paid on initial submission without manual intervention—as a more meaningful financial health indicator. He advocated for coordinated workflows, involving front desk to billing, supported by detailed data analytics to identify denial trends, top payer issues, and optimize staff effort. The goal is to minimize redundant claim scrubbing, streamline operations, and improve revenue capture. The session closed stressing collaboration, transparency, and using actionable data to drive continuous improvement in denial management and practice revenue, preparing attendees for evolving reimbursement challenges in 2026.

Keywords

2026 Reimbursement Reset

first pass payment rate

clean claim rate

claim adjudication pipeline

denial management

medical billing optimization

revenue cycle management

data analytics in healthcare

practice revenue improvement