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

May was a heavy month for independent practices. Payers are still skirting No Surprises Act requirements. HIPAA security updates are closer than most practices realize. And a new report confirms what many already feel: independent physicians now represent just 18% of the field — down significantly from a decade ago. The practices still standing need every operational and financial edge available.

Below, 10 stories worth your attention and what to do about each one.

Details: In a letter to HHS and other federal agencies, the American Medical Association (AMA) and others say health plans are circumventing the statute with harmful policies that shift costs onto patients and undercut independent physician practices. Here’s an AMA summary of the letter. Groups specifically call for increased federal agency enforcement and greater transparency around the independent dispute resolution process.

Why it matters: When payers don’t follow the requirements of the No Surprises Act, physicians can face delayed payments, increased administrative burden, and greater financial pressure—particularly in independent practices that have limited resources to absorb ongoing reimbursement disputes.

What’s next: Closely monitor payer payment patterns and dispute outcomes, strengthen internal tracking of denied or underpaid claims, and stay engaged with evolving federal enforcement efforts as regulators face growing pressure to increase transparency and oversight of No Surprises Act compliance.

Details: HIPAA security updates set to take effect this year include stronger protections for patient data, greater visibility into where patient data resides, more defined expectations for incident response, and more. View the proposals here.

Why it matters: Once the updated HIPAA security rule takes effect, providers will have 60 days to comply. Physicians should prepare now, even though the HIPAA Security Rule updates are still in a proposed/finalization phase.

What’s next: Conduct a comprehensive security risk assessment, strengthen cybersecurity safeguards such as multi-factor authentication and encryption, review business associate relationships, test incident response plans, and improve staff education around cybersecurity threats.

Details: In the absence of federal regulations governing artificial intelligence (AI) use in prior authorization and claims review, states have created their own safeguards. Each state law related to the use of AI in prior authorization and/or claim review has its own unique requirements, but major themes include requiring human review of denials, mandating disclosure of AI use, allowing audits of algorithms, limiting inappropriate use of patient data, and more.

Why it matters: A growing patchwork of state AI regulations could create additional operational complexity for physicians and practices, particularly those operating across multiple states or dealing with numerous payers.

What’s next: Monitor how the health plans are using AI in prior authorization and claims review, track denial trends for unexpected changes, strengthen documentation to support medical necessity, and stay informed about evolving state and federal requirements that could affect payer workflows and reimbursement.

Details: UnitedHealthcare recently announced that by the end of 2026, it will eliminate prior authorization requirements for an additional 30% of services that currently require approval. Note: This does not mean a 30% reduction across all healthcare services. UnitedHealthcare says prior authorization currently applies to only about 2% of medical services, so the company is removing 30% of the remaining prior authorization requirements, not eliminating prior authorization broadly.

Why it matters: Reducing prior authorization requirements could lower administrative burden, decrease staff time spent on submissions and appeals, and speed patient access to care.

What’s next: Monitor updated payer policy lists and workflow changes because practices may need to revise authorization processes, staff protocols, and denial-tracking strategies as these changes roll out through 2026.

Details: According to KFF, while most states plan to use less restrictive policies and automate work verification where possible, a smaller group intends to implement requirements before January 1, 2027, or use stricter approaches such as more frequent eligibility checks and longer look-back periods for compliance verification.

Why it matters: A state's specific work requirement policies may directly influence patient coverage stability and practice operations. More restrictive requirements could increase coverage churn (i.e., patients repeatedly gaining and losing coverage), leading to more eligibility verification work, more uninsured or self-pay visits, delayed care, appointment cancellations, and higher uncompensated care. Practices may also see more staff time devoted to helping patients understand eligibility changes, complete paperwork, or resolve coverage problems.

What’s next: Monitor how your state plans to implement Medicaid work requirements. Then strengthen eligibility verification and coverage-monitoring workflows and prepare for potential increases in coverage churn that could affect scheduling, reimbursement, and patient access to care.

Details: A recent position paper from the American College of Physicians (ACP) raises concerns about the burden of prior authorization, unexpected costs, barriers to physician and post-acute care access, fragmented quality measures, aggressive marketing practices, and payment policies that may encourage favorable patient selection. ACP recommends stronger oversight of Medicare Advantage plans, more transparent and standardized benefit designs and cost disclosures, streamlined prior authorization processes, improved accountability around supplemental benefits, and protections against contractual restrictions that interfere with physician decision-making.

Why it matters: This position paper establishes a physician-backed framework for potential Medicare Advantage reforms related to prior authorization, transparency, physician autonomy, and patient access.

What’s next: Monitor Medicare Advantage policy developments, track administrative and access barriers affecting patients, and stay engaged through specialty societies and advocacy efforts as discussions around prior authorization reform, transparency, and physician autonomy continue to evolve.

Details: According to a recent survey of clinically inactive physicians, the reasons physicians leave clinical practice early are shifting, with burnout, chronic workplace stress, administrative burden, and unrealistic patient expectations now emerging as leading drivers rather than older factors such as malpractice costs or personal health concerns. The mean age of physicians who left clinical practice was 48.1 years, 9 years younger than observed in a similar cohort in 2008.

Why it matters: The findings suggest that efforts to address physician shortages should focus not only on expanding the physician pipeline but also on retaining existing physicians through workplace improvements, reduced administrative burden, and stronger support systems such as flexible scheduling and family support resources.

What’s next: Prioritize retention strategies that address the root causes of dissatisfaction—reducing administrative burden, improving workflow efficiency, supporting work-life flexibility, and creating practice environments that promote long-term professional sustainability and well-being.

Details: While most older Americans are open to engaging with digital health tools, 85% of respondents to a recent CVS Health study say they don’t understand how to use digital health platforms effectively. CVS Health summarized its findings in this white paper.

Why it matters: As healthcare increasingly shifts toward patient portals, telehealth, digital scheduling, online prescription management, and AI-enabled tools, digital literacy is becoming a key factor affecting patient engagement and outcomes. Patients who struggle to navigate technology may miss appointments, delay care, have medication adherence problems, misunderstand treatment instructions, or face difficulty managing chronic conditions—all of which ultimately create more work for physicians and staff.

What’s next: Assess whether their digital tools are accessible and easy for patients to use, identify populations at higher risk for digital barriers, and incorporate support strategies such as patient education, simplified workflows, and alternative communication channels to prevent technology from becoming a barrier to care.

Details: Eighty-two percent of physicians are now employed by hospitals or corporate entities (e.g., private equity firms or health insurers), marking a continued decline in independent practice, according to a recent report.

Why it matters: For independent physicians, the findings raise questions about long-term sustainability and competitive pressures in increasingly consolidated markets.

What’s next: Evaluate how changing ownership and employment trends align with long-term goals, carefully assess employment agreements and partnership structures, and identify ways to preserve clinical autonomy, financial sustainability, and operational flexibility as consolidation continues.

Details: A recent scoping review of 366 studies on secure messaging through patient portals found that these communications promote better diabetes and hypertension management, increased preventive screening participation, and improved patient satisfaction. However, significant challenges remain, including increased clinician workload and burnout from growing message volume, digital literacy and access barriers that disproportionately affect vulnerable populations, privacy concerns, and unclear workflows around message use and reimbursement.

Why it matters: Secure messaging is increasingly becoming part of routine clinical care rather than a supplemental communication tool, creating both opportunities and challenges for physicians.

What’s next: Evaluate secure messaging workflows by monitoring message volume and after-hours work, establish clear expectations for patient communication, consider team-based inbox management strategies, and explore AI-supported tools for triage and response drafting while maintaining human oversight and preserving patient trust.

That's May's Vital Signs. The thread running through this month: administrative complexity is accelerating while the independent practice ecosystem shrinks — which means your billing workflows, payer relationships, and compliance readiness matter more than ever. We'll be back in June.