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 2025 ends and 2026 begins, physicians find themselves in a period of transition. While the December 31 deadline for Medicare participation decisions has passed, physicians now navigate the immediate impact of deductible resets, updated fee schedules, and new CPT codes.

Here’s a roundup of 10 important new stories from December 2025 and their potential impact on your medical practice or billing company.

The specifics: On December 17, 2025, the United States House passed H.R. 6703, a Republican healthcare bill that notably excludes an extension for enhanced premium tax credits. While the bill purportedly aims to lower premiums for specific demographics and expand access to association health plans for freelancers and small businesses, it reduces total subsidies. If passed, it could lead to premium hikes for millions of Americans.

Why it matters: Because the Senate delayed action until January, the credits technically expired December 31. This creates immediate financial uncertainty for patients. If these credits aren't extended retroactively, practices may see a rise in uninsured patients or an increase in self-pay balances as patients struggle with higher monthly premiums. Meanwhile, a greater share of Americans than previously suggested experience burdensome healthcare costs, according to results from a nationally representative cohort study.

What’s next: Monitor the Senate's movement on the Democratic-led discharge petition in January. In the meantime, ensure your front-office staff is prepared to discuss coverage changes with patients who may be affected by subsidy shifts.

The specifics: Some physicians are far likelier than others to use telehealth for patient visits on a weekly basis, according to a new AMA Policy Research Perspectives report. Psychiatrists lead the way, with 85.9% reporting weekly video visits. Other top specialties include:

Why it matters: These figures provide a benchmark for practices to measure their own digital engagement. If your specialty is on this list and your telehealth volume is significantly lower, you may be losing patient market share to more digitally forward competitors.

What’s next: Audit your 2025 telehealth volume. If you aren't at least meeting your specialty average, evaluate whether your current technology is a barrier for patients or whether you need to adjust your clinical workflows to better prioritize remote visits.

The specifics: A recent study shows that patients increasingly select asynchronous e-visits over telephone, video, or office visits for 4 common conditions: UTIs, seasonal allergies, acne, and international travel consultations. These structured interactions often resolve care without the need for a follow-up within 7 days. 

Why it matters: E-visits offer a high-resolution rate without the scheduling dead time of a live video call. For a busy practice, this is a scalable way to increase patient throughput and satisfaction without clogging the physical (or virtual) waiting room.

What’s next: Review your current patient portal capabilities. If you aren't already billing for asynchronous e-visits, investigate the specific CPT codes and payer requirements to turn these routine inquiries into a legitimate revenue stream.

The specifics: HHS recently announced a new AI strategy to scale AI across public health, healthcare delivery, biomedical research, and human services. The plan emphasizes governance, workforce readiness, and modernization to improve efficiency and patient outcomes while managing risk and public trust.

Why it matters: This strategy signals that federal oversight of AI is arriving. For RCM leaders, this means future AI tools, whether for coding or managing denials, will likely face stricter standards.

What’s next: When you vet new software partners (or new features from existing ones), go deeper than "AI" as a buzzword. Ask vendors specifically about where they keep humans in the AI loop and how they ensure their algorithms remain compliant with emerging HHS guidance.

The specifics: A recently published commentary suggests that AI could be a tool for patients as well as providers. Patient-directed AI could let patients choose their tools, verify medical advice, and consider viewpoints institutional systems might miss.  

Why it matters: This paper shifts the view of AI from a passive tool to a potential way for patients to gain empowerment and agency, allowing people to take a more active role in their decisions, collaborate in shaping their health stories, and question constraints imposed by the system.

What's next: Train clinicians to guide patients on using AI responsibly. Include AI literacy in discussions with patients, so they know not only how you apply AI technologies to their treatment, but also how to interpret the results, recognize the limitations, and balance AI-based advice with their individual preferences and values.

The specifics: A recent study found that setting aside just one appointment slot per half-day specifically for asynchronous EHR tasks, such as messaging, prior authorizations, and prescription refills, decreased physician burnout by 81%. It also decreased EHR after-hours use and EHR non-workday use. Notably, this change resulted in only a slight decline in mean relative value units.

Why it matters: Burnout is a major driver of staff shortages and administrative errors. This study shows that protecting admin time doesn't have to negatively impact practice revenue.

What’s next: Pilot a protected EHR block in your medical practice for one month. Track EHR after-hours use, non-workday EHR activity, and productivity (before and after implementation to demonstrate impact.

The specifics: Integrating prior authorization software directly into the EHR workflow is significantly associated with lower denial rates and faster treatment times, according to a recent study.

Why it matters: Manual prior authorization creates delays and clinician burnout. This study finds that real-time transparency at care can simplify workflows, speed up treatment access, and lower costs.

What’s next: Assess your current denial rates related to authorizations. If they are rising, it may be time to move away from manual portals and toward an EHR-integrated automation tool.

The specifics: According to the Health Care Transformation Task Force, between 2022 and 2024, ACOs taking on downside risk under the Medicare Shared Savings Program (MSSP) delivered higher gross shared savings and better quality scores than those in upside-only models.

Why it matters: The trend in RCM is moving toward accountability. Organizations that lean into risk, invest in the infrastructure to support it, and remain committed over time realize higher rewards than those that stay in safer, traditional models.

What’s next: If you are part of an ACO, review your data infrastructure. To succeed in a downside-risk model, you must have the analytics capabilities to identify high-cost patients before they impact your savings.

The specifics: Medicare Payment Advisory Commission (MedPAC) issued draft payment update recommendations for 2027 that include a 0.5 percentage point increase in physician payment rates above current law. 

Why it matters: While any increase is welcome, a 0.5% boost is insufficient to keep pace with rising practice costs and represents MedPAC’s acknowledgment of that.

What’s next: Don't wait for legislative relief. Assume Medicare margins will remain tight and focus on optimizing coding/compliance and diversifying your payer mix where possible.

The specifics: Starting July 1, 2026, the CMS Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model will move Medicare from fee-for-service to value-based care by linking payments to patient outcomes and promoting tech-driven preventative care.

Why it matters: This model could accelerate broader adoption of technology-enabled care models and influence future policy on how Medicare pays for care delivery.

What’s next: Evaluate your current digital health infrastructure. To participate in ACCESS or similar future models, you will need robust care management tools that can track patient outcomes over time.