InSights 

2026 CPT® to Include AI-Related Codes

For 2026, you can look forward to a new coding system that provides better documentation of “technology-enabled care,” which includes remote patient monitoring (RPM), digital health services (e.g., telehealth and wearables), and medical services enhanced or augmented by AI. This is all courtesy of the AMA, which recently released its 2026 CPT code set, comprising 418 total changes, including 288 new codes, 84 deletions, and 46 revisions to existing codes.

For example, providers will be able to document RPM for a shorter duration, including monitoring for 2 to 15 days within 30 days. Two new codes also describe RPM after 10 minutes of service per calendar month, instead of the previous 20-minute threshold.

Several new codes have been introduced for health AI services. For example, CPT codes were added for AI-augmented assessment of coronary atherosclerotic plaque and perivascular fat analysis to inform cardiac risk. The CPT 2026 code set will also include new codes for AI-assisted services, such as multi-spectral imaging for burn wounds and the detection of cardiac dysfunction.

The codes, which will be effective for use starting January 1, 2026, will not only help to better document/chart patient encounters, but will also be vital to claims processing and reimbursement, particularly in Medicare.

Click here for CPT coding details from the AMA.

(ADSRCM, with our own AI-driven automation, helps ensure correct coding is used based on current published NCCI edits and LCD/NCD edits, alleviating that stressor from our clients. And, our RPM option and the Medics Telemedicine app will help you keep patients engaged yet mobile while generating revenue for you!)

Post-COVID Phenomenon: Patients have Increasingly Stopped Paying some Medical Bills

According to a recent JAMA Health Forum release, which uses data from 2018 to 2024, there’s a declining trend in patient payments for hospital visits. It also covered outpatient settings.

Of the 6.2 million patient episodes of care studied, nearly 70% of those had “positive liability,” meaning patients owed some money for care they received. The monthly average liability owed was approximately $375 per person per episode for patients with private insurance and about $170 for those with Medicare Advantage.

Perhaps unsurprisingly, patients were less likely to pay their hospital bills when their balances were higher. To illustrate, repayment rates among the privately insured, and essentially the same for Medicare Advantage patients, showed that balances paid over $1,000 were generally under 35%, compared to about 50% for bills of approximately $100. 

Click here for the JAMA Health Forum report.

(The tools and technology you need to help ensure your patient balances are paid are supported by ADSRCM and our outsourced services. These include eligibility verifications, out-of-network alerts, an automated prior authorizations option, access to our patient responsibility estimator, which is excellent for avoiding surprises, and we support multiple ways for patients to pay. Interactive balance due reminder texts and emailable statements, both with built-in payment mechanisms, are available. Our insurance discovery option is ideal for identifying coverage for patients with no listed insurance. If in-house automation is preferred, ADS clients can take advantage of these same features through the MedicsPremier platform.)

Immunization Schedule Update

The CDC has updated its adult and child immunization schedules, applying individual-based decision-making to COVID-19 vaccinations and recommendations. Specifically, toddlers are now recommended to receive protection from varicella (chickenpox) as a standalone immunization, rather than in combination with measles, mumps, and rubella vaccination.

These recommendations by the CDC Advisory Committee on Immunization Practices (ACIP) were approved earlier in the month (October) by Acting Director of the CDC and Deputy Secretary of Health and Human Services Jim O'Neill (my namesake but not related).

By the time you read this, the schedules will have already been updated on CDC.gov.

The recommendation emphasized that the risk-benefit of vaccination in individuals under age 65 is most favorable for those who are at an increased risk for severe COVID-19 and lowest for individuals who are not at an increased risk, according to the CDC list of COVID-19 risk factors. The FDA has approved marketing authorization for COVID-19 vaccines for individuals who have one or more of these risk factors, as well as for individuals age 65 and older.

Regarding individual-based decision-making, the CDC's immunization recommendations incorporate input from healthcare providers, including physicians, nurses, and pharmacists. It means that the clinical decision to vaccinate should be based on patient characteristics that, unlike age, are difficult to incorporate into recommendations.

Click here for details from the CDC’s newsroom.

Not Becoming a Manager is a Thing

According to LinkedIn’s latest Workforce Confidence Index survey, only 30% of survey respondents spanning all industries want to become managers over the next few years. Healthcare is among the highest with staff not aspiring to be managers.

You may already be having a hard time recruiting and retaining medical and administrative staff, let alone identifying those who are both qualified to be managers/supervisors and who want to step into those roles.

This new aversion to being a manager may pose a significant challenge for you in the future.

Click here for the LinkedIn survey.

(We can’t help you identify potential managers, but we can help you consolidate your in-house staffing issues with ADSRCM’s behind-the-scenes outsourced workforce of billing and workflow specialists! Offload a myriad of time-consuming hands-on tasks such as claims, denial management, eligibilities, prior authorizations, claim tracking, EOB reconciliations, patient balances, and more, including how your patients will call us when they have statement questions!)