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This week we're talking about the money patients owe you and what happens when they can't write you a check on the spot.
Plus: tariffs on branded biologics, a new oral psoriasis drug that shifts revenue off your books, 8.3 million people about to lose Medicaid, Google rewriting the rules on how patients find you, and a payment plan math problem hiding in plain sight.
Let's dive in.
THE WEEKLY BRIEFING
📰 Here’s what you missed last week:
The White House issued a proclamation imposing tariffs up to 100% on patented pharmaceutical imports, with a 120-day phase-in starting April 2. Biosimilars and generics are exempt, but branded biologics common in derm (Dupixent, Skyrizi, Tremfya, Cosentyx) could see significant price increases that ripple into patient affordability and prior auth volume.
Google's March 2026 core update started rolling out March 27 and should finish around April 10-11. Practices with original, experience-backed content will gain visibility; thin pages and AI-generated filler will drop.
FDA approved icotrokinra (Icotyde), the first oral IL-23 inhibitor for moderate-to-severe plaque psoriasis in adults and patients 12+. This shifts prescribing from medical benefit (J-code, infusion) to pharmacy benefit (oral Rx), which changes how practices bill and get paid for biologic-class treatments.
KFF projects 8.3 million Medicaid expansion enrollees at risk of disenrollment under OBBBA's 80-hour/month work requirements, effective January 2027, with 5.3 million expected to lose coverage entirely. For practices with Medicaid-heavy payer mixes, this is a slow-moving coverage gap worth watching now (we covered the broader OBBBA implications in What the "One Big Beautiful Bill" Means for Independent Dermatology).
AI search is reshaping how patients find providers: AI Overviews cut click-through rates from 1.6% to 0.6%, 230 million weekly health queries now run through ChatGPT, and 31% of users never click past the AI answer. Practices investing in site speed and structured content are seeing organic traffic gains of 27.1%.
CareCloud disclosed a breach after hackers accessed patient records in 1 of its 6 EHR environments. SEC filing and forensic investigation are underway; if your practice uses CareCloud, check for vendor communications and review your BAA.
A bipartisan bill (H.R. 8163) would reform Medicare's budget neutrality mechanism, the formula that forces pay cuts to some specialties whenever others get increases. Derm has been on the losing end of this math before, so this one is worth tracking through committee.
DEEP DIVE
💰 Patients Can't Pay in Full. Now What?
Practices that offer payment plans collect 77% of self-pay balances. Practices that demand full payment at time of service collect 7%.
The gap is not subtle, and the math behind it keeps getting worse. The average single-coverage deductible hit $1,886 in 2025. Over half of commercially insured adults reported financial stress from healthcare costs last year. 36% of U.S. households are carrying medical debt, with the national total north of $220 billion. A patient who owes $800 after a procedure isn't dodging the bill. They don't have $800.
The practices still running rigid collection policies are watching the same cycle repeat: patient gets a bill they can't cover, bill goes to a collection agency, practice recovers pennies on the dollar, patient finds a new provider. Cedar's 2023 data showed providers without payment plans leaving 93% of self-pay balances on the table. One health system that implemented structured payment plans saw patient responsibility revenue jump 173%, pulling in over $15 million in additional payments within 12 months.
Why practices resist
If the data is this clear, why do so many independent practices still default to "pay in full today"? Three reasons, all of which are more reasonable than they look from the outside.
Operational complexity is real. Running payment plans without infrastructure means someone on your staff is tracking installments in a spreadsheet, chasing missed payments manually, and reconciling partial balances against the PM system every month. For a four-provider practice with two front desk staff, that's not a minor addition to the workload. It's a second job layered on top of check-in, checkout, prior auths, and phone triage. Most practices that tried payment plans informally and abandoned them did so because the manual overhead ate whatever revenue they recovered. The ones that succeed either automate card-on-file billing through their PM system or use a third-party platform that handles the installment tracking entirely.
Compliance confusion is reasonable. The Truth in Lending Act (TILA) and its implementing rule, Regulation Z, require specific disclosures when a provider extends credit to a patient. If you charge interest, assess finance fees, or structure a plan with more than four installments, you're classified as a creditor under federal law, which triggers disclosure requirements, documentation rules, and potential liability. That sounds like a compliance minefield, and for practices without legal counsel on retainer, the safe move feels like not offering plans at all. But the threshold is more workable than it sounds. A plan with four or fewer installments, no interest, and no finance charges falls outside TILA's scope entirely. A $600 balance broken into four monthly payments of $150, documented in a simple written agreement, requires no special disclosures and no creditor classification. The HFMA's compliance guidance walks through this threshold in detail.
For balances too large for four payments, third-party financing options like CareCredit or Sunbit shift the compliance burden off your books. The practice gets paid upfront. The patient gets terms they can manage. The financing company handles the regulatory requirements.
Inertia has a dollar cost that's hard to see. When a practice doesn't offer payment plans, the cost doesn't show up as a line item. It shows up as rising days in A/R, growing bad debt write-offs, and patient attrition that gets attributed to scheduling or location rather than billing friction. 72% of consumers under 35 say they'd switch providers for a better payment experience, which means the practices losing patients to rigid billing policies may not realize that's the reason. The revenue you never collect and the patients who quietly leave don't generate a report. They just erode the collections metrics that matter most.
Takeaways
Collect a card on file at every check-in and offer auto-pay enrollment (skip the credit card surcharges). 57% of patients want to hear about payment options before or at the time of service, not after. Make it part of intake, not an afterthought.
Structure payment plans at four installments or fewer to stay under the TILA threshold (no interest, no finance charges, simple written agreement). For larger balances, route to third-party financing. You stay out of creditor territory; patients get flexibility.
Train front desk staff to bring up payment plans before the patient asks. The conversation should start at check-in, not after a past-due notice. Give your team a script and the authority to set up plans on the spot. Only 11% of dermatology practices offer financing without the patient raising it first.
UPCOMING EVENTS + REMINDERS
📆 Mark your calendars:
MGMA Private Practice Conference — Early Registration Deadline — April 10, 2026. Save $200 on the MGMA Private Practice Conference (May 3-5, St. Louis) by registering before this date. Register at mgma.com
MGMA Operations Conference — April 12-14, 2026. Conference for medical practice professionals focused on operational processes and patient-ready care, held in Charlotte, NC. Details at mgma.com
Diversity in Dermatology Conference — April 16-19, 2026. Sessions on humanitarian medicine, therapeutics, immunodermatology, and aesthetics. Conference agenda
AAD Innovation Academy — Early Registration Closes — April 22, 2026. Last day for AAD members to lock in the 30% early-bird discount for Innovation Academy (July 16-19, NYC). Important dates at aad.org
AAD Innovation Academy — Scientific Poster Submissions Due — April 30, 2026. Deadline to submit scientific poster abstracts for the 2026 AAD Innovation Academy. Submit at aad.org
MIPS 2026 MVP Registration Opens — Open now through November 30, 2026. Register for MIPS Value Pathways for the 2026 performance year. QPP deadlines at cms.gov
Until next week,
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Clarity RCM manages revenue cycle for 200+ dermatology practices across 42 states. It's all we do. See how we work.
