Weekly roundup
Here’s what you missed last week!
🏛️ Policy & Payers
FDA loosened iPLEDGE pregnancy test requirements for isotretinoin, allowing home tests with clinician sign-off.
Kaufmann makes the case that AI scribes can tighten coding accuracy in derm as reimbursement pressure grows.
High-cost biologics are driving dermatology spending higher, with value-based care floated as the fix.
Scripps Health says its Medicare Advantage exit paid off after $75M in annual MA losses, and other systems are taking notes.
Sens. Warren and Hawley introduced a bill banning insurers from owning providers, targeting vertical integration in healthcare.
📈 Business & Tech
Experts outline strategies to tighten billing efficiency for clinicians, with workflow redesign and denial management top of list.
AI won't fix your revenue cycle if your workflows are still fragmented, per a new ambulatory practice readiness report.
Anterior raised $40M to scale an AI platform that cuts prior auth from weeks to minutes.
Doctors are quietly adopting AI tools for charting and coding, even where their institutions haven't signed off.
🩺 Clinical
AI healthcare tools aren't delivering where clinicians and staff haven't been trained to use them.
The next wave of at-home healthcare moves past monitoring into predictive, assistive care.
💡 Marketing & Growth
99% of US hospitals now use social media, and physicians are getting new guidance on reputation management as patient acquisition shifts online.
The Deep Dive
The $9 fee that costs you $15,000
A 3% surcharge on a $300 credit card payment recovers $9. A loyal derm patient generates $12,000 to $15,000 in lifetime revenue. One bad checkout experience, and that patient is shopping for a new dermatologist.
Credit card surcharges are gaining traction. 35% of merchants now add them, and ModMed Pay just rolled out an automatic surcharge feature. Your peers are asking about it. Your office manager brought it up at last week's team meeting.
Before you flip that switch, read the fine print.
The legal picture
Your payer contracts probably block it too. Most commercial contracts include "payment in full" clauses defining the allowed amount plus cost-sharing as the maximum you can collect. A surcharge pushes the total past that. The Journal of Urgent Care Medicine notes that adding fees "begs the question of whether a provider is requiring payment above and beyond the assignment."
Five jurisdictions ban surcharges outright. Connecticut, Massachusetts, Maine, Puerto Rico, and effectively California. SB 478, in effect since July 2024, bans adding fees beyond the advertised price with $1,000 fines per infraction. Eight more states cap or restrict them, including Colorado (2%), Oklahoma (2%), and New York (actual processing cost only).
Debit cards, HSA cards, and FSA cards can never be surcharged. That's federal law (the Durbin Amendment). And since your front desk can't always tell a credit card from a debit card at a glance, mistakes are practically guaranteed.
The patient math
Behavioral economics settled this question decades ago. Nobel laureate Richard Thaler showed in Marketing Science (1985) that people perceive surcharges as direct losses, while equivalent price increases register as opportunity costs. Loss aversion makes the surcharge feel roughly twice as painful as a price increase of the same amount.
Credit card companies understood this so well they lobbied Congress to require that any price differential be framed as a "cash discount" rather than a "credit card surcharge." If Visa doesn't want customers seeing surcharges, your patients won't love them either.
The retention data backs it up. J.D. Power's 2026 study found that nearly 1 in 3 businesses report customers walking away from transactions when they hit a surcharge. The California Dental Association puts it more starkly: 55 to 75% of customers say they're less likely to return.
And 56% of patients would switch providers after a bad billing experience. For patients under 26, that jumps to 74%.
Cosmetic patients are especially exposed. They're paying 100% out of pocket. They chose you over alternatives. They'll choose someone else just as easily.
The operational impact
Even if the legal and retention risks don't stop you, the daily grind will.
Your front desk has to explain the fee to every card-paying patient, handle complaints, identify credit versus debit (not always obvious), exempt HSA and FSA cards, post signage at the entrance and checkout, and notify Visa and Mastercard 30 days before starting. In multi-state practices, they're also tracking different rules by state.
All of this for $9 on a $300 transaction.
Surcharge vs. convenience fee: know the difference
They're not the same thing. A surcharge is a percentage fee added when a patient pays with a credit card at the point of sale. A convenience fee is a flat dollar amount charged for paying through an alternative channel, like an online portal or over the phone.
Convenience fees have fewer state restrictions and don't require card network notification. But they must be flat (not a percentage), must apply to all payment types in that channel, and must include a fee-free alternative.
What to do instead
Lindsay Ethredge, Director of Client Services at Clarity RCM, put it simply when a client asked: "Adjust your private-pay or cosmetic fee schedule by 2 to 3% across the board."
Behavioral economics confirms the logic. A $309 charge feels like a normal price. A $300 charge plus a $9 surcharge feels like nickel-and-diming. Same revenue, different patient experience.
Takeaways
Don't surcharge insured patients. Most commercial payer contracts prohibit it. Penalties go up to $20,000 per violation. The risk isn't worth it.
Check your state before surcharging anyone. Even for self-pay and cosmetic services, surcharges are banned in 5 jurisdictions, restricted in 8 more, and subject to card network rules everywhere. If you do it: verify your state allows it, cap at 3%, post signage, and notify Visa/MC 30 days in advance.
Raise your fee schedule instead. A 2 to 3% bump across private-pay and cosmetic services recovers the same revenue with zero patient friction, zero compliance risk, and zero front-desk headaches. Patients won't notice. Your staff will thank you.
Bottom line: Processing fees eat roughly $25,000 a year per physician. The fix is a pricing adjustment, not a checkout surprise.
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.
