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.

February brought a range of notable headlines, including President Donald Trump’s signing of federal legislation that extends telehealth flexibilities for another 2 years. However, this progress in telehealth does not eliminate ongoing uncertainty about the effects of expired insurance subsidies, which previously helped lower insurance premiums for approximately 22 million people last year. 

Additional key topics this month include: 

Details: President Trump recently signed legislation ending a partial government shutdown and extending pandemic-era telehealth and hospital-at-home flexibilities through 2027. Other wins stemming from this legislation include expansion of the Medicare Diabetes Prevention Program, restoration of a 3.1% bonus for physicians participating in Medicare Alternative Payment Models, and more.

Why it matters: The telehealth extensions protect a revenue stream on which many practices continue to rely, particularly as more Medicare patients leverage virtual appointments for common chronic conditions like diabetes and high blood pressure. The extensions also provide stability and predictability so practices can plan staffing, scheduling, and technology investments with greater confidence. 

What’s next: Consider using this window of policy stability to: 

Details: A recent survey found that nearly 2 in 3 Americans (62%) gave up on trying to find information in their patient portal because it was too confusing. Respondents report spending an average of 20 minutes searching before giving up. 

The most common pain points patients report? 

Even simple tasks like finding test results, messaging providers, or scheduling appointments were difficult for many users.

Why it matters: Portal confusion directly affects patient outcomes, practice efficiency, and revenue. If patients can’t find results, send messages, or schedule appointments, they default to calling the office — which increases front-desk burden, hold times, and clinician inbox volume. 

If patients can’t locate statements, understand balances, or connect multiple health systems, self-pay A/R and bad debt risk increase. In addition, when patients don’t understand where to look for information, physicians lose a key engagement channel designed to streamline communication and improve satisfaction scores.

What’s next: Treat portal usability as a clinical and revenue issue — not just an IT problem. For example:

Even deciding when and how to flag abnormal lab results in the portal can make a big difference in terms of patient navigation. 

Details: Nearly 53 million prior authorization requests were submitted to MA insurers on behalf of MA enrollees in 2024, according to a new KFF report. MA insurers denied 7.7% of these requests. Substantially fewer prior authorization requests (i.e., 625,000) were made for traditional Medicare during that same timeframe.  

Why it matters: Physicians treating MA patients may face a dramatically higher administrative burden that can negatively impact throughput, scheduling, and revenue predictability.

What’s next: Consider aligning clinical protocols with MA medical necessity criteria to reduce preventable denials. Also consider:

Details: UnitedHealthcare recently announced on its website that beginning February 1, 2026, providers must submit all post-service appeals electronically. This applies broadly to network commercial and Medicare Advantage providers and facilities (with a few plan-specific exceptions).

Why it matters: As UnitedHealthcare and other payers continue to move toward paperless appeals, practices could see faster turnaround and tracking. Digitizing appeals also reduces the risk of lost or delayed documentation that, in turn, helps protect revenue.

What’s next: Smaller practices and those without integrated payer portals or application programming interfaces may need to train staff on portal processes or build/upgrade technology. Now’s the time to work out any kinks in the process and explore the potential for technological changes. 

Details: According to a recent survey, 70% of health plans expect alternative payment model activity to increase over the next 24 months, citing provider readiness, health plan engagement, and health plans’ ability to operationalize such models as key facilitators.

Why it matters: As more payer contracts are tied to quality metrics, cost performance, risk-sharing, and data reporting, physicians who are unprepared may find themselves reacting to payer-driven models instead of shaping them — often with compressed timelines and unfavorable contract terms.

What’s next: Evaluate these workflows now:

Then invest in improving analytics and documentation, and align physicians around small, measurable quality goals to prepare for value-based contracting opportunities. 

Details: A recent survey found that most adults have at least ‘a fair amount’ of trust in their doctor for reliable information about health issues. Only half say they trust the CDC or FDA, and fewer than half express trust in their state government officials, HHS Secretary Robert F. Kennedy, Jr., or President Trump.

Why it matters: The survey results show that doctors are now seen as the most trustworthy link between patients and the healthcare system. This role gives them both influence and responsibility.

What’s next: Stay abreast of initiatives to help patients and the public navigate information effectively. In addition: 

For example, the University of Birmingham is creating The Health Chatbot Users’ Guide, which will clearly outline risks and opportunities and provide practical tips on how the public can obtain helpful and safe results from chatbots.

Details: According to CMS’s 2025 Medicare Fee-for-Service Supplemental Improper Payment Data, CMS projects it overpaid E/M code 99214 by $459 million in 2024. Another problematic E/M service was clinical staff time spent on chronic care management (99490) that the agency overpaid 65% of the time, resulting in $205 million in overpayments that same year.

Why it matters: Since 99214 is one of the most frequently billed E/M codes in primary care and many specialties, the recent CMS improper payment data increases the likelihood of targeted medical reviews and potential payer scrutiny. The error rate for 99490 suggests systemic documentation gaps that could serve as low-hanging fruit for recoupments. 

What’s next: Audit your use of 99214 and 99490 to ensure documentation clearly supports code assignment. For 99214, this includes ensuring clear documentation of medical decision-making and/or time. For 99490 it also includes consent, care plan requirements, and more. The goal is to be able to defend these services as Medicare and other payers increase scrutiny.

Details: CMS recently announced the development of a Medicare App Library that will serve as a trusted, centralized directory where people with Medicare can discover and access vetted digital healthcare options. The agency said all apps in the library will have undergone rigorous evaluation to ensure they meet high standards for security, privacy, clinical evidence, usability, and equity.

Why it matters: The Medicare App Library supports CMS’s broader push toward digitally enabled, outcome-based care models like CMS’ Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model. ACCESS tests an outcome-aligned payment approach designed to expand access to new technology-supported care options that help people with Original Medicare improve their health and prevent and manage chronic disease. 

What’s next: Stay up to date on the types of digital tools in the library, recognizing ones that align with your practice’s patient population. Also, be on the lookout for apps that support your reimbursement strategy by producing measurable outcomes that matter in alternative payment models or models like ACCESS.

Details: The Bipartisan Policy Center recently published an issue brief highlighting the misalignment between clinical adoption of artificial intelligence (AI) tools and current Medicare payment systems. More specifically, authors of the brief say Medicare’s current fee-for-service structure doesn’t consistently or clearly reimburse the use of AI tools, creating financial uncertainty and uneven adoption.

Why it matters: If AI reduces volume, eliminates waste, or improves prevention, it can paradoxically shrink revenue — unless the practice participates in value-based models that financially reward improved outcomes and lower costs.

What’s next: Identify AI tools that directly support billable services (e.g., improving documentation quality for E/M coding, automating prior authorizations, or enhancing chronic care monitoring) so adoption strengthens current cash flow rather than undermines it. 

Also, build AI into practice workflows to support quality measures, care coordination, and cost outcomes (e.g., predictive analytics for high-risk patients) so you can position your practice for success in value-based payment models, including those that reward technology-enabled value.

Discover how Tebra’s integrated medical billing platform helps your practice maximize revenue. Book a free, personalized demo today.