“Vital Signs" is a monthly RCM column for private practices and medical billers. Each edition covers the headlines that matter and what to do about them. Browse previous editions.

The healthcare landscape continues to shift rapidly, creating new financial, operational, regulatory, and technology challenges for private practices. Rising healthcare costs, evolving federal policies, increasing payer scrutiny, cybersecurity risks, and changing patient expectations are reshaping how practices deliver care, manage their operations, and protect the revenue cycle management (RCM) processes that keep them financially healthy.

At the same time, providers are navigating growing administrative complexity while working to preserve patient trust, improve access to care, and protect practice revenue. Success will increasingly depend on proactive planning, stronger workflows, thoughtful technology adoption, and clear communication with both patients and payers. 

This month's updates highlight the developments private practices should be watching — and the practical steps they can take to prepare.

Details: National healthcare spending in the US is projected to reach nearly $9 trillion by 2034, representing 20.6% of the economy, up from $5.3 trillion and 18% of gross domestic product in 2024, according to Centers for Medicare & Medicaid Services (CMS projections. Commercial healthcare costs are expected to rise 9% in 2027. CMS Administrator Dr. Mehmet Oz recently outlined the agency's strategy for making healthcare more affordable during Healthcare Financial Management Association (HFMA)’s annual conference.

Why it matters: Less than half of Americans can afford quality healthcare, according to a recent Gallup poll, and many have decided to forgo coverage entirely. Experts say coverage losses will likely increase in 2027 as further federal cuts to subsidies and new enrollment barriers take effect. 

What’s next: Identify financial barriers early and make cost conversations part of routine care planning. Offer price transparency, discuss lower-cost treatment alternatives when clinically appropriate, and connect patients with financial assistance or insurance enrollment support. Streamline prior authorization, eligibility verification, and denial workflows to reduce avoidable administrative costs. Take these steps to help preserve access to care and reduce the likelihood that patients delay or forgo needed treatment because of cost.

Details: The House Appropriations Committee unanimously adopted an amendment to the FY 2027 Labor-HHS appropriations bill stating that none of the funds in the bill — or any other act — could be used to implement the WISeR model or any similar model that adds prior authorization to traditional Medicare.

Why it matters: Defunding the WISeR pilot could bring relief for patients and providers alike, many of whom have experienced care delays and increased administrative burden, respectively. 

What’s next: Congress still has to move the House language through the full appropriations process before it would actually stop WISeR funding. That means WISeR remains in effect for now, so providers and practices in the six pilot states should continue complying with current requirements while closely monitoring the appropriations process.

Details: One in five (21%) U.S. working-age adults with private insurance reported that they or a family member had experienced an insurance company denial of coverage for medical care recommended by a doctor in the past year, either before or after the care was provided.

Why it matters: When one in five privately insured adults reports a denial, practices experience more staff time spent on prior authorizations, appeals, resubmissions, and patient phone calls, all of which increase overhead without generating revenue. Denials can also delay treatment, lead to cancelled appointments or abandoned care plans, and make it harder for patients to pay their bills — especially if they receive unexpected out-of-pocket costs after a payer refuses coverage.

What’s next: Track denials by payer, service line, CPT code, and denial reason to identify patterns early. Strengthen documentation before submission, standardize prior authorization workflows, and train staff to escalate high-risk denials quickly. Talk with patients before care when coverage is uncertain, and explain appeal rights, financial options, and next steps clearly. Use denial data to push back with payers, support contract discussions, and protect patients from unnecessary delays in care.

Details: Nearly one-third of adults use digital sources for health guidance each month, according to a recent poll: 31% turn to social media, and 29% use AI tools or chatbots — a share that has nearly doubled in two years from about one in six (17%).

Why it matters: As patients continue to turn to social media and AI to manage their health, it can raise expectations for fast digital access, increase the need to correct misinformation, and create longer or more complex conversations during visits, portal messages, and phone calls. It also means practices have an opportunity to strengthen trust by offering clear, credible digital education, improving their online presence, and making it easier for patients to find reliable guidance through the practice rather than turning elsewhere first.

What’s next: Publish clear educational content, reinforce trusted messages through the patient portal and website, and train staff to address misinformation without dismissing patients’ concerns. Encourage patients to bring in information they found online so clinicians can clarify what is accurate, what is misleading, and what applies to their specific situation.

Details: In 2024, 70% of patients (92% of portal users) viewed results in their patient portal, and 58% (76% of portal users) viewed the results before hearing from their healthcare provider, according to a recent analysis. However, only 66% of patients reported that they understood the results they viewed in their patient portal. Provider encouragement, higher education, and digital literacy were most strongly associated with higher rates of viewing test results overall and before hearing from their healthcare provider. 

Why it matters: When patients see their test results in the portal before a clinician has a chance to explain them, they may experience anxiety that can drive more follow-up calls and portal messages and create extra work for already stretched clinical and front-office staff. Without adequate support, patients may struggle with confusion and become dissatisfied. 

What’s next: Set clear expectations for when test results will appear in the portal and how patients should interpret them before discussing them with a clinician. Use plain-language result notes, follow-up messaging, and staff outreach protocols for abnormal or sensitive findings so patients are not left to interpret complex results on their own. Also consider incorporating patient preferences for communicating test results in case some patients prefer not to receive results before speaking with a physician. Encourage portal use while also identifying patients with lower digital literacy who may need extra support or alternative communication methods. Strengthen these workflows to reduce patient confusion, ease message volume, and improve the overall patient experience. 

Tebra Take: Providing test results is only one part of the patient experience. Practices that pair digital access with educational resources, follow-up messaging, and personalized communication can improve patient understanding, satisfaction, and trust.

Details: From 2018 to 2026, an average of 34% data breaches had business associate involvement, according to a recent analysis. That’s up from an average of 20% between 2009 and 2017.

Why it matters: Independent practices often outsource billing, coding, credentialing, transcription, cloud EHR hosting, patient communications, AI documentation, and other services. That means a practice's cybersecurity is only as strong as its vendors' security.

What’s next: Inventory every vendor that accesses protected health information, review business associate agreements annually, and perform routine vendor security assessments. Require vendors to use multifactor authentication, encryption, and documented incident response plans, and verify how AI and cloud vendors protect patient data. Finally, develop a breach response plan that clearly defines each party's responsibilities before an incident occurs, rather than during one. If the vendor leverages AI in some way, be sure to check out this new AI cyber governance framework implementation guide.

Details: 44% of physicians say patients have less trust in their treatment recommendations today than they did several years ago, according to a recent survey. However, 88% said their patients still trust them personally. Four in 10 of physicians surveyed said trust-related issues have influenced their career plans, including their consideration of leaving clinical practice, reducing their hours, or switching employers.

Why it matters: Patient trust is essential to clinical outcomes, patient retention, and physician satisfaction. Declining trust in medical recommendations can lead to more questions, lower treatment adherence, longer visits, and greater administrative burden as clinicians spend more time addressing misinformation and explaining care decisions. Over time, that added strain can contribute to physician burnout and turnover — particularly in smaller practices with limited staffing and fewer resources to absorb additional workload.

What’s next: Invest in communication strategies that strengthen patient trust, including shared decision-making, empathetic listening, and clear explanations of treatment recommendations. Give physicians enough time and support to address patient questions, misinformation, and concerns without feeling rushed. Reinforce trust beyond the exam room through consistent follow-up, patient education, and transparent communication.

Details: American Medical Association (AMA)’s CPT Editorial Panel has updated its AI taxonomy (Appendix S) to better reflect how artificial intelligence is being used in clinical practice and to support more accurate coding and reimbursement as AI adoption accelerates. To date, the CPT Editorial Panel has accepted 43 AI-classified CPT codes spanning code years 2021 through 2028, covering applications in specialties such as cardiology, oncology, ophthalmology, and diabetes management.

Why it matters: The AMA says these changes will help physicians better understand the level of clinical oversight required when using AI tools. The revisions do not create new CPT codes; instead, they clarify the framework used to classify AI-enabled medical services and procedures. This includes creating clearer distinctions between the three AI categories — assistive, augmentative, and autonomous — particularly between assistive and augmentative technologies.

What’s next: Ask vendors whether their product is considered assistive, augmentative, or autonomous under the CPT AI taxonomy and how much physician oversight is expected. Also monitor new CPT codes and payer policies that reference Appendix S so the practice can code AI-enabled services correctly and avoid compliance issues.

Details: A new final rule reduces Independent Dispute Resolution (IDR) fees to $15, expedites eligibility checks to five days, expands claim batching, and increases transparency to fix No Surprises Act bottlenecks. No Surprises Act compliance remains a significant enforcement priority for CMS, with surprise billing and payer payment practices continuing to generate thousands of complaints

Why it matters: The new rule lowers the cost and administrative burden of challenging inadequate out-of-network payments under the No Surprises Act, making the federal IDR process more accessible and practical for smaller practices with limited staff and resources.

What’s next: Update payment dispute workflows to take advantage of the lower IDR fees, faster eligibility determinations, and expanded claim batching. Also identify eligible claims early, strengthen documentation, and monitor payer payment patterns to maximize reimbursement opportunities.

Details: A new federal rule establishes a nationwide operational framework to roll out Medicaid work requirements designed to promote economic stability, self-sufficiency, and independence. The rule also defines which individuals are not subject to the requirement because of health-related needs and other qualifying circumstances. 

Why it matters: Medicaid work requirements could affect patients' eligibility and coverage continuity, potentially leading to more uninsured patients, interruptions in treatment, and higher uncompensated care. Practices should be prepared to identify patients at risk of losing coverage, educate eligible patients about exemption criteria, and connect them with enrollment or financial assistance resources to help maintain access to care. About 55% of Medicaid enrollees are completely unaware that work requirements will become a condition of eligibility starting January 2027, according to a recent survey. An additional 27% say they have heard something but are unsure of the details.

What’s next: Providers should educate front-office and care management staff about the new work requirement and exemption criteria so they can help patients navigate coverage changes. They should proactively identify Medicaid patients who may be at risk of losing coverage and connect them with enrollment assistance, social services, or financial counseling before care is disrupted. Practices should also monitor state implementation timelines and update eligibility verification and patient communication workflows as the requirements take effect. The AMA also encourages physicians to shape their state’s hardship exemptions.

Tebra Take: Changes in insurance eligibility can create downstream challenges for scheduling, billing, and collections. Integrating eligibility verification, patient communication, and financial workflows can help practices reduce claim denials, minimize uncompensated care, and support revenue cycle performance.

As these trends continue to evolve, independent physician practices that stay informed and adapt proactively will be better positioned to protect financial performance, strengthen patient relationships, and reduce administrative burden. By translating policy changes and emerging industry developments into practical action, practices can improve operational resilience while continuing to deliver high-quality patient care.

That's June's Vital Signs. The thread running through this month: rising costs and eroding trust are converging on the same pressure point — practices are being asked to do more reassurance, more documentation, and more advocacy with the same staff and shrinking margins. Denials, prior authorization uncertainty, and vendor risk aren't side issues anymore; they're core to whether a practice stays financially healthy.