Payer policy, coding rules, and collections practices are all shifting at once this year. Staying reactive costs practices real revenue. Here’s what’s changing and what to do about it.
Policy Changes Worth Watching
A new federal vaccine order could mean more office visits — and more billing questions. The order calls for spacing childhood vaccines like MMR across separate visits rather than combined doses, and gives HHS 90 days to explore single-disease shot options. No standalone MMR component vaccine is currently manufactured in the U.S., and it isn’t yet clear whether insurers will reimburse the additional visits the policy envisions.
Source: Austin Littrell, Medical Economics
A dense stretch of Medicare and Medicaid changes is coming. Payment rates, prior authorization rules, telehealth flexibilities, and Medicaid coverage terms are all set to shift at different points between September 14, 2026 and January 1, 2028. Practices that build a rolling compliance calendar now will handle this far better than those reacting deadline by deadline.
Source: Medical Economics, Medicare & Medicaid coverage
Dental practices: confidence is up, but reimbursement still isn’t keeping pace. The ADA Health Policy Institute’s Q2 2026 State of the U.S. Dental Economy report found dentist confidence climbing, with patient volume and spending both up. But long-term reimbursement rates are still trailing inflation and the rising cost of running a practice — the gap hasn’t closed, it’s just less visible when the waiting room is full.
Source: Texas Dentists for Medicaid Reform, reporting on ADA HPI data
Billing and Coding
AI helps billing most at intake — not at the back end. AI’s clearest payoff in revenue cycle management is at patient intake and eligibility verification, where it catches the wrong policy numbers and lapsed coverage responsible for a large share of preventable denials. Coding decision-support and predictive denial scoring matter too, but only pay off once that front-end data is already clean. Fix intake first, then coding accuracy, then prediction — not the reverse.
Source: Purnendu Bala, Medical Economics
FY 2027 ICD-10 updates land October 1 — start reviewing now. CMS’s FY 2027 ICD-10-CM code set takes effect October 1, 2026. Industry coding groups are already urging billers and compliance staff to review the changes ahead of the deadline rather than scrambling on day one.
Source: American Medical Billing Association
Dental practices: your PPO fee schedules are probably overdue for a renegotiation. Most PPO contracts allow fee renegotiation roughly every two years — a window many practices never use. A full audit of every plan you participate in is the starting point for identifying which contracts are underpaying you relative to the market.
Source: Verimedix
Patient and Insurance Reimbursement
Collecting Medicare Advantage copays at the front desk is getting harder. Many Medicare Advantage plans now discourage collecting copays at time of service, pushing practices to wait for claims adjudication before billing. Post-service statements cost more to generate and are far less likely to get paid. The practical fix is updating front-desk scripts and financial policy to reflect the delay.
Source: Glenn N. Pomerance, M.D., Medical Economics
“Friendly fraud” and credit-invisible patients are both eating into collections. Reporting points to a rise in chargeback disputes from patients claiming a service wasn’t delivered — particularly common in telehealth — alongside a large population of patients who lack traditional credit scores and need alternative financing to afford care. Practices pairing fraud-detection tools with flexible, third-party patient financing are seeing meaningfully higher upfront collections.
Source: Todd Shryock, Medical Economics
Dental: real-time eligibility checks remain your best defense right now. More payers are moving toward real-time eligibility verification and automated claims adjudication, which industry trackers expect will eventually shrink the weeks-long gap between submission and payment. Until that shift is universal, verifying eligibility before every appointment is still the single most effective way to keep denials and A/R backlog from piling up.
Source: CareRevenue
Where to Start
None of this has to be handled alone. If you want a clearer picture of where your own practice stands on denials, collections, and coding accuracy, start here:
And if you’d rather just talk it through, we offer a free 30-minute Practice Analysis where we look at your actual numbers together — no obligation, no cost.