Welcome to “Vital Signs,” your go-to monthly roundup of all things related to RCM tailored for private practices and medical billers. Access previous editions for top insights and developments.

As January comes to a close, uncertainty still surrounds the healthcare sector, with lingering questions about telehealth options, ACA plan sign-ups, and other issues. 

Here’s a roundup of 9 important revenue cycle management (RCM) news stories this month. Take the time to review them and discuss potential impacts on your medical practice or billing company.

Details: Beginning April 1, UnitedHealthcare will not separately reimburse providers for both an E/M service and a global radiology code billed for the same patient on the same day unless the radiology report is attached, per a Jan. 1 provider bulletin.

Why it matters: Payment now hinges on attaching the radiology report, not just coding correctly. Specialties that may be hit the hardest include those where providers perform in-office imaging frequently, such as: 

What’s next: Ensure imaging is clinically distinct and medically necessary. Build automatic attachment workflows that attach finalized radiology reports at claim generation and leverage edits to stop claim submission when reports are missing.

The specifics: The Centers for Medicare & Medicaid Services (CMS) recently implemented an online form that providers can use to voice complaints about Medicare Advantage plans. According to a CMS memorandum announcing the form, complaints will be placed into a queue where CMS will review and triage them. 

Why it matters: Instead of complaints being anecdotal and fragmented, they’re now standardized, structured, and actionable, making it possible for CMS to detect patterns and potentially drive change. 

What’s next: Leverage this form consistently but selectively by prioritizing problems that are: 

The specifics: President Trump recently announced he would replace government subsidies for health insurance with direct payments to consumers. To date, around 800,000 fewer people have selected ACA plans compared to a similar time last year, according to an analysis of CMS data. This marks a 3.5% drop in total enrollment so far. 

Two-thirds of the public (66%) say they worry about being able to afford healthcare for themselves and their family, ranking higher than utilities, food and groceries, housing, and gas, according to a recent poll. While most states aren’t fully replacing the enhanced premium tax credits, some states are offering new state-funded health insurance premium assistance for 2026.

Why it matters: With these changes, providers may see higher self-pay balances after insurance, more payment plans, slower accounts receivable, and higher bad debt.

What’s next: Plan to verify eligibility earlier and more often. In addition, 

The specifics: On January 22, 2026, the House passed an appropriations package that includes a 2-year extension for telehealth flexibilities. The bill has not yet been approved by the Senate.

Why it matters: Even if the Senate approves it, a 2-year extension still signals ‘temporary,’ not permanent, making it difficult to plan long-term. AMA experts say permanent telehealth reform is critical. 

What’s next: Physicians must ask these important questions: 

The specifics: Eighty-nine percent of respondents to a recent AMA survey identified scope of practice as a top priority for 2026, beating out Medicaid policy pressures, workforce shortages, and other issues.

Why it matters: The survey confirms that physicians across the country see protecting physician-led care as essential to patient safety and the stability of care teams. 

What’s next: Ensure clear attribution of clinical decisions, defined escalation protocols, and explicit supervision structures. 

The specifics: AI scribe adoption was associated with increases in RVUs and encounters per week, with no evidence of increased denials, according to a recent study. 

Why it matters: The use of ambient AI scribing continues to increase as providers explore ways to increase efficiency and decrease administrative burden.

What’s next: Experts say the real value isn’t just saving doctors time typing notes; it’s what happens after the note is created. As these tools get built directly into electronic health records (EHRs), the ones that matter most will be those that help with accurate coding, billing, and fewer claim denials — not just transcription. 

The specifics: Misuse of AI chatbots and unpreparedness for a ‘digital darkness’ event top ECRIs’ list of health technology hazards for 2026.

Why it matters: Both of these hazards have the potential to threaten patient safety. AI chatbot tools increasingly interact with patients and staff without clear guardrails. In addition, extended EHR outages, cyberattacks, cloud failures, or vendor disruptions can shut down scheduling, documentation, medication management, billing, and even basic communication.

What’s next: Establish clear rules for: 

In addition, strengthen disaster recovery planning by establishing downtime procedures and implementing reliable data backup processes. Also, ensure organizational readiness through training, tabletop exercises, and safety drills.

The specifics: A recent study found that traditional Medicare denied 26.8% of services for health-related social needs — including social determinants of health risk assessment, community health integration, and principal illness navigation — in 2024. 

Why it matters: These findings may help explain why many providers hesitate to scale social-care interventions — even when evidence supports them. 

What’s next: To promote revenue integrity and decrease denials, tightly connect social-risk assessments and navigation services to specific clinical conditions, care plans, and outcomes. Authors of the study say future work can identify and test interventions for reducing barriers to providing and accessing HRSN-related services.

Details: Reuters recently reported that UnitedHealth Group will return profits generated from its Affordable Care Act plans to customers, according to a prepared statement by Chairman and CEO Stephen Hemsley before the House Energy and Commerce Health Subcommittee. 

Healthcare Finance News quoted Hemsley as follows: “Though UnitedHealthcare is a relatively small participant in the individual ACA market, we will voluntarily eliminate and rebate our profits this year for these coverages, as Congress continues to work toward more long-term solutions,” Hemsley said in a prepared testimony.”

Why it matters: While ACA rebates are not uncommon, what’s novel is the fact that UnitedHealth is doing it voluntarily and also amid declining ACA enrollment, subsidy uncertainty, and debates about affordability and insurer profits.

What’s next: When UnitedHealth Group returns ACA profits, it increases pressure to rebalance margins elsewhere. While it’s too early to tell, this could translate to: 

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