Weekly roundup
Here’s what you missed last week!
🏛️ Policy & Payers
Faster processing is coming to North Dakota and Nebraska via new laws requiring prior authorization decisions.
Administrative complexity may rise in Alaska under a new law requiring PBM licensing and prohibiting most claim denials based on timing.
Practice revenue faces volatility in New York as 140,000 residents see insurance premiums spike 38% following expired tax credits.
Reimbursement transparency is under fire as Anthem sues 11 hospitals for allegedly flooding the dispute resolution process with ineligible claims.
📈 Business & Tech
Modernizing operations is a necessity as 71% of leaders say the revenue cycle requires a total overhaul rather than small fixes.
Physician burnout persists with 81% of doctors expressing frustration over their employer’s approach to adopting new AI tools.
Automated engagement is expanding as Transcarent adds voice AI scheduling and symptom-checking to its patient platform.
⭐ Just for Fun
The Deep Dive
January is the most misunderstood month in the revenue cycle
January brings a familiar rhythm to independent dermatology. You open your remits and see an increase in $0.00 payments from payers. It’s common for billing teams to hesitate when insurance payments dip, but in most cases, the money hasn’t disappeared. The responsibility has just shifted.
Why this happens every year
On January 1, deductibles reset for the vast majority of commercial plans. According to the CMS National Health Expenditure Projections, out-of-pocket spending is projected to grow steadily through 2033, though at a slower rate than private insurance and government payers.
For the commercially insured patients walking into your practice, this change is felt from the very first visit. The 2025 Kaiser Family Foundation (KFF) Employer Health Benefits Survey reports that the average deductible for a single worker is now nearly $1,900, with more than a third of workers facing deductibles above $2,000. In practical terms, this means the first few visits of the year often result in insurance paying nothing. The full allowable amount is transferred to the patient.
Where revenue gets stuck
When an EOB comes back with $0 paid by the insurer, workflows tend to break down in three places:
The information gap: If the patient is billed only after the EOB is processed (typically 30 days post-visit), they have usually forgotten the details of the service. Receiving a $150–$300 statement in February, when the last thing they remember is a $40 copay in December, creates confusion and delays.
Administrative drag: Back-office teams spend time explaining deductibles to patients who believe their plan covers the visit. That effort pulls focus away from higher-value work like resolving denials or confirming benefits for surgical cases.
Collection timing: MGMA data consistently shows that the likelihood of full collection drops the longer a balance sits in accounts receivable. Collecting at the time of service remains one of the most effective ways to reduce bad debt.
How high-performing practices respond
While you can’t change insurance design, you can change how your practice absorbs it. That starts with verifying deductibles before the visit rather than relying on an “active” status in your PM system. If a patient has a $3,000 deductible and has met $0, you should know exactly who is responsible for the cost of that excision before they arrive.
It also means normalizing card on file. Card on file remains the most effective tool for managing high deductibles. When a zero-pay EOB returns, the patient receives a notice that their balance has been finalized by their insurer and the card will be charged in 3-5 days. This approach works best when expectations are set before the visit.
Finally, teams should be refreshed on the difference between “allowed” and “billed.” Patients usually react to the full billed charge shown on their EOB. Training billing teams to explain that the insurer reduced the charge to the contracted rate (but applied it to the deductible) helps patients understand that the insurance did work — it obtained a discount — even if it didn't issue a payment.
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That’s it for this week.
This one was super fun. Hope you enjoyed it too.
