Weekly roundup
Here’s what you missed last week!
🏛️ Policy & Payers
Expect fair reimbursement in disputes as providers are winning 80% of No Surprises Act arbitrations and getting paid above the median rate.
Look for a reduction in red tape now that NCOIL has adopted the Prior Authorization Reform Model Act to standardize insurer protocols.
Watch for new defenses against automated refusals as New Hampshire lawmakers introduce bills to ban AI-driven claims audits.
Keep your current workflows in place after UnitedHealthcare delayed its restrictive remote monitoring policy due to provider pushback.
📈 Business & Tech
Stabilize your operations against the Q1 dip by preparing now for the January cash flow crunch caused by deductible resets.
Evaluate your practice model as the number of concierge and direct primary care clinics in the U.S. continues to rise.
⭐ Just for Fun
The Deep Dive
What 2025 made clear about running a practice
It’s been a busy year, and for many, the gap between rising costs and shrinking reimbursements has never felt tighter. Between the latest round of Medicare cuts and persistent inflation, many practices spent 2025 figuring out how to do more with less without burning out their teams.
As the year wraps up, there’s a few patterns worth reflecting on.
Finding the margin
With the CMS 2025 Physician Fee Schedule introducing a 2.83% conversion factor cut, running a tight ship became a requirement. Small leaks inside a practice carried more financial weight than ambitious growth plans.
Across workflows, preventable breakdowns consistently drove revenue loss. Incomplete eligibility checks at intake led to denials. Documentation gaps resulted in downcoding or prolonged appeals. These rework cycles quietly drained margin.
When a billing lead spends hours chasing a $150 claim due to a missing modifier or incorrect insurance ID, the effort can cost more than the payment itself. Practices that performed best in 2025 prioritized clean claims at the source rather than relying on downstream fixes to recover revenue.
Automating the right tasks
Even with over 70% of practices now using some form of AI, the conversation shifted this year. The most effective teams stopped treating technology as a cure-all and applied it to time-intensive, non-clinical work, like ambient scribing and document routing.
That shift paid off in practical ways. By reducing repetitive administrative work, staff had more capacity for patient-facing tasks, and providers spent less time finishing charts after hours. In a year when labor remained the largest expense, using technology to extend the capacity of existing teams proved to be one of the most reliable ways to manage rising overhead.
Staying independent
Consolidation pressure didn’t ease this year, with the AMA reporting that fewer than 43% of physicians remain in independent practice.
For practices that stayed the course, agility mattered. The ability to move quickly on payer relationships, staffing decisions, or front-end policies without waiting for corporate approval became a real advantage in an unpredictable year.
Bottom line: 2025 stripped away the shortcuts. Practices that protected margin, improved the patient experience, and stayed independent did so by getting the fundamentals right and repeating them consistently.
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That’s it for this week.
This one was super fun. Hope you enjoyed it too.
