Weekly roundup
Here’s what you missed last week!
🏛️ Policy & Payers
The FTC told healthcare firms to review potentially illegal noncompete contracts.
California passed two bills to streamline approvals and speed care, per Becker’s.
Aetna and Optum will pay $8.4M over “dummy code” practices, says Healthcare Dive.
Benefit costs are set to rise 6.5%-10%, driven by chronic disease and drugs, per Becker’s.
AMA added 288 CPT codes for 2026 across monitoring, AI, and digital health, via Healio.
📈 Business & Tech
Organizations that operationalize analytics outperform, says MedCity News.
Penguin Ai raised $29.7M to automate prior auth and coding, per MedCity News.
Oracle Health unveiled AI for RCM, prior auth, and trials, reports Fierce Healthcare.
Headway embedded AI notes and telehealth in its EHR to streamline provider tasks, via Fierce Healthcare.
Home-based dermatology visits grew 600% post-pandemic, says Healio.
🩺 Clinical
Leaders are training on documentation integrity amid AI and risk-adjustment shifts, per AAPC.
Clinicians should address risks of skin-bleaching products with women of color, per Healio.
AI is upgrading POCUS for faster diagnostics and safer procedures, argues MedPage Today.
Rising dermatology imaging needs stronger privacy guidance, notes Healio.
💡 Marketing & Growth
Fix the journey, then ask for loyalty: CareFirst is rethinking member experience by simplifying engagement, via Becker’s.
Patient stories still shift perceptions and adoption more than slogans, says MedCity News.
⭐ Just for Fun
The Deep Dive
Can’t Find Your Contracts? Payers Are Counting On It
Too many dermatology practices don’t have their payer contracts on file... or worse, they aren’t sure if they ever saw them. That’s a blind spot you can’t afford. If you don’t know the rules of the game, you can’t tell whether you’re being paid correctly, leaving money (and leverage) on the table.
Why It Matters: Payer contracts are the foundation of your financial relationship. They set the ground rules on:
Reimbursement rates: the fee schedule you’ll be paid under.
Timely filing: how long you have to submit claims.
Coverage carve-outs: services excluded or reimbursed differently.
Pathology is the classic trap. If you bring pathology in-house but your contracts carve it out, you could sink capital into a new lab only to discover your claims don’t pay the way you modeled. Without the contract language or a specialized billing partner, you can’t know if you’re getting paid right... or if you’re building on sand.
Can’t Find Your Contracts? Start Here.
If your payer contracts are MIA, you’re not alone. Here’s how to track them down:
Check old inboxes. Look through the email of whoever handled credentialing. Search for “contract,” “agreement,” or DocuSign/Adobe Sign.
Ask your credentialing service. Many external firms keep signed agreements on file.
Go straight to the source. Reach out to provider relations or log into payer portals. Fair warning: some payers only accept requests by fax (yes, still) and may drag their feet. Persistence pays - these are your contracts, and you’re entitled to them.
Getting your contracts is just step one. Next, make them usable:
Centralize and secure. Store contracts in one accessible location so your team isn’t hunting when an issue arises.
Consolidate your fee schedules. Work with your billing team to build a master grid of allowed amounts across payers. That way, you can spot underpayments at a glance instead of payer by payer.
Can You Negotiate Rates?
Short answer: yes, but leverage is everything. Payers are more likely to consider when you can show...
...high patient volume they don’t want to lose.
...unique services, like being the only Mohs surgeon in a 20-mile radius.
...serving underserved geographies where the plan needs coverage.
It’s tougher if you’re a startup or in a saturated metro market, but not impossible. Negotiation is a game of timing, positioning, and persistence. We’ll dig into specific strategies in an upcoming edition.
📊 Want to see how your fee schedules stack up against peer dermatology groups? Clarity can help.
Bottom line: If you don’t know what your contracts say, you don’t know whether you’re getting paid fairly. Find them, centralize them, and make them work for you, not against you.
The Toolkit
Things to check out this week
📄 Article You Need: Aetna, Optum settle “dummy codes” case — quick compliance read; use it to refresh coding audits and EDI edit rules with your team.
🛠️ Tool You Should Try: Rivet Payer Contract Manager — centralize contracts and spot underpayments so your rates aren’t theory, they’re enforced.
🎧 Event Alert: AMA CPT & RBRVS 2026 Annual Symposium — Nov 19–21, 2025 (virtual). Get the 2026 code updates straight from AMA before templates and fee schedules lock.
Need a pro?
When you're ready for an expert to make your practice's billing bulletproof, schedule a strategy call with our team.
That’s it for this week.
This one was super fun. Hope you enjoyed it too.
