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.

For medical practices and billing companies alike, November is a high-pressure month. You are likely balancing patient billing inquiries and packed schedules with end-of-year revenue pushes. On top of that, Affordable Care Act open enrollment began November 1 and concludes December 15 regardless of the current flux in subsidy negotiations. 

Meanwhile, providers face a critical question: will they continue to participate in Medicare? It’s a decision they must make by December 31. This looms alongside the need to understand the CY 2026 Medicare physician fee schedule final rule and ensure you are up to date on telehealth claim submissions following the government shutdown. 

Here’s a roundup of 7 important stories from this month to help you navigate the changes for your practice or your clients.

The specifics: On October 31, 2025, the Centers for Medicare & Medicaid Services (CMS) released its CY 2026 physician fee schedule final rule. It brings a whole slew of changes related to payment policies, payment calculations, quality metrics, and more that take effect January 1, 2026. 

Why it matters: The impact will be unique to each medical practice, depending on the mix of services, setting (facility- versus office-based), payers, and other factors.

What’s next: Take the time to review the final rule and understand the impact on your specific medical practice. If you provide telehealth, be sure to also review this updated telehealth Q&A from CMS. As you plan for 2026, consider:

The specifics: On November 12, 2025, President Trump signed a continuing resolution that extends telehealth waivers through January 31, 2026. This includes allowing the home to serve as the originating site for non-behavioral visits and permitting audio-only non-behavioral visits. 

Why it matters: The extension avoids an immediate cliff, but it's not a long-term solution. The lack of permanence makes it difficult for practices and billing teams to plan resources and processes for the year ahead.

What’s next: While experts say more permanent support may be on the way, consider running scenario modeling for telehealth billing now. Determine the revenue impact and operational cost of shifting back to in-person visits if the waiver expires without renewal in January.

The specifics: On November 20, 2025, CMS clarified that providers may now resubmit claims for telehealth services with a date of service on or after October 1, 2025, that were held or returned during the government shutdown. These are payable if they meet Medicare requirements. 

Why it matters: If you don't correctly track and resubmit these claims, your practice or your clients risk significant revenue leakage from the shutdown period.

What’s next: Identify telehealth services from October 1, 2025, onward that were held, returned, or not submitted. Compile a list by provider, date, service code, and CMS claim status. If you have returned claims (CARC 16, RARC M77) or claims held because of the shutdown, review whether they now qualify for resubmission per CMS guidance. If so, coordinate with Medicare administrative contractors and internal teams to resubmit them immediately.

The specifics: Sixty-eight percent of physicians identify autonomy as the top benefit of self-employment, according to a recent survey. Conversely, respondents said income uncertainty as the worst part. While 70% said they feel financially secure, this is a drop from 81% in 2022.

Why it matters: Autonomy directly impacts patient care. It allows for quicker decisions, care tailored to individual needs rather than bureaucratic protocols, and stronger doctor-patient relationships. A lack of autonomy often drives burnout.

What’s next: If you run a practice, consider benchmarking physician autonomy. If you are a billing partner, look for ways to reduce the administrative burden that threatens that autonomy.

The specifics: A new study found that a simple portal questionnaire — using the Caregiver Intensity Index linked to resources and supported by in-clinic materials — successfully identifies and engages care partners with minimal changes to clinician workflow.

Why it matters: Millions of Americans provide health and function-related help to family (broadly defined). These care partners provide critical support but are rarely identified or supported during care delivery.

What’s next: Seek new opportunities to engage care partners. This aligns with quality, patient experience, value-based care imperatives.

The specifics: Fewer than 15% of family physicians reported ideal interoperability experiences — defined as often obtaining, finding, and reconciling external data within their EHRs — in 2024, according to a recent study. Even when information imported automatically, they frequently indicated that it was difficult to find or use.

Why it matters: Poor interoperability leaves physicians without complete, accurate information at the point of care. When data does not flow automatically, practice and billing staff must engage in manual workarounds — calling providers, scanning documents, and re-ordering tests. This increases administrative burden, denial risk, and staff overtime, all of which compress profit margins.

What’s next: Physicians (especially private ones) must become more deliberate technology decision-makers rather than passive users. Systems that block data flow or make reconciliation painful will increasingly become financial and professional liabilities.

The specifics: The AMA released a new resource to help private practices vet technologies for value-based care efforts. It includes guidance on negotiating vendor agreements and case studies from practices that have successfully adopted new tools.

Why it matters: As reimbursement moves away from pure fee-for-service toward value-based care, providers and their billing partners must adopt technologies that support population health management, outcome tracking, and cost control.

What’s next: Review the guide before making your next tech investment. Performing a tech-gap assessment is a critical first step that can help connect investments to real value-based outcomes.

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