The implementation of a successful revenue cycle management (RCM) program for anesthesia practices is more complex than ever before. Ongoing challenges include payor policy changes that significantly increase operational complexity and cost, continued increase in payor denials, increased deductible and cost shifting to patients, and an increase in the cost and administration to manage new federal programs such as the No Surprise Act legislation (O’Reilly. One wrinkle to surprise billing law? Health plans aren’t paying up, 2025). It is important to have confidence that your RCM program is sophisticated enough to navigate and manage this changing environment. The anesthesia specialty requires unique expertise and technology to ensure claims are billed and paid in compliance with all commercial and government payor regulations. New technological advancements in artificial intelligence (AI) and machine learning are having a meaningful impact on operational quality and efficiency (Forbes Expert Panel. 19 Major Impacts AI is having on the healthcare industry, 2024). These technologies must be implemented correctly and with appropriate compliance oversight; otherwise, a practice will suffer from increased errors, revenue loss, and significant additional costs. While each of these topics could be discussed at length individually, in this chapter, we highlight the foundational compliance and operational elements as well as the required investment in new technologies that are necessary to run an effective anesthesia RCM program in 2026 and beyond.