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December 2025 |
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from ADSRCM for Comprehensive, Transparent Outsourced Billing/Staffing Services
As 2025 draws to a close, healthcare practices and laboratories across the country are reflecting on a year marked by profound change — from regulatory reform and financial pressure to rapid shifts in technology.
No matter your specialty — whether it’s primary care, imaging, behavioral health, addiction treatment, orthopedics, podiatry, neurology, wound care, or laboratory services — the demands of 2025 likely challenged your operations, your team, and your bottom line.
At ADS, we’ve been tracking these developments closely. More importantly, we’ve been responding in real time — enhancing our platforms, supporting our clients, and preparing for what’s ahead.
Here’s a brief recap of what mattered most in 2025, and what to anticipate in 2026.
Telehealth Became a Standard of Care
Telehealth officially transitioned from convenience to necessity — supported by permanent CMS expansions, including:
Home-based and audio-only visits
Hybrid care delivery models
Expanded virtual visit codes across specialties
As the digital front door widens, practices must ensure seamless workflows, accurate modality coding, and airtight documentation. We continue to strengthen MedicsCloud EHR with exactly these needs in mind.
Workers’ Comp and Personal Injury Went Digital
In 2025, WC and PI saw one of the most significant digital transformations in years — particularly in states like Florida.
Key trends included:
Telehealth evaluations for injuries
Digital-first claims and EORs
Lien status tracking and structured data submission
AI-enhanced documentation and settlement transparency
Our RCM solutions now include features tailored for these cases — including an attorney portal, case-specific billing, and automation tools that minimize staff effort while maximizing accuracy.
Financial Pressures Mounted Across the Industry
This past year reinforced a critical truth: practices that rely on outdated systems and manual workflows are at a disadvantage.
According to MGMA and HFMA data:
Nearly half of practices reported flat or declining revenue
Denial rates exceeded 10–13% across the board
Staffing gaps and higher overhead eroded margins
Practices using MedicsRCM — or managing billing in-house via our MedicsCloud Suite — were better positioned to weather the storm.
👉 See how MedicsRCM supports performance
Regulatory Complexity and Operational Burden Increased
With new prior auth rules, coding updates, and stricter payer policies, practices without AI-backed, rule-based platforms faced:
Higher denial rates
More clinician documentation burden
Limited insight into A/R and performance metrics
Our MedicsCloud Suite and MedicsRCM both integrate automation and our AI Rules Engine to address these challenges directly.
Prior Authorization Reform Begins January 2026
The CMS Interoperability & Prior Authorization Final Rule introduces strict new timelines:
Urgent requests must be processed within 72 hours
Standard requests within 7 calendar days
All denials must include clear, actionable reasoning
Public reporting of approval and turnaround metrics begins
In short: the clock is ticking. Electronic prior auth becomes the standard in 2027. We’re already building it in.
WISeR Pilot Launches in Six States
Beginning January 1, Medicare will require prior authorization for 17 outpatient procedures in AZ, NJ, OH, OK, TX, and WA.
Specialties impacted include:
Radiology and imaging
Pain management
Orthopedics
Neurology
Ambulatory surgery
Documentation demands will only tighten as this pilot expands.
Reimbursement Pressures Will Persist
Between reimbursement cuts, documentation demands, and ongoing PA complexity, practices must:
Prioritize clean claims
Automate eligibility and billing checks
Optimize documentation at the point of service
Prepare for value-based care tracking
Strengthen telehealth compliance
Integrated Systems Are No Longer Optional
Modern practice performance depends on unified workflows — from scheduling and engagement to billing, analytics, and telehealth.
Revenue Cycle Automation Is a Must-Have
Clean-claim performance is the foundation of profitability. Practices should invest in:
Front-end verification tools
Prior auth automation
Intelligent claims scrubbing
Denial analytics and task management
Interoperability Will Define Success in 2027 and Beyond
Systems must seamlessly connect with:
Payers
Labs
Pharmacies
Remote monitoring devices
HIEs
Other EHRs
Hybrid Care Is the New Normal
Remote intake, digital reminders, online payments, and telehealth aren’t "extras" — they’re essential to patient access and financial performance. We’ve built these into our solutions from the ground up.
Advance our EHR, PM, and RCM platforms
Expand AI-driven automation
Strengthen documentation compliance
Lead in interoperability
Offer both outsourced and in-house solutions
Deliver specialty-specific expertise
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January, with more articles of interest in the world of RCM.
You can maximize revenue and productivity with outsourced services from ADSRCM. If you prefer in-house automation, the MedicsPremier platform from ADS can be deployed! Contact us at 844-599-6881 or email rcminfo@adsc.com for more information, and about the ADSRCM guarantee to increase your revenue in 90 days.
We strive to produce our monthly newsletters with news articles from the same month! We greatly appreciate feedback or comments on our newsletters/content. Please opine by emailing christina.r@adsc.com or by calling 800-899-4237, Ext. 2264. We’d love to hear from you!
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