Medicare payment pressure set the tone at MGMA’s centennial meeting
At MGMA’s 100th annual conference in San Antonio, the policy backdrop was impossible to ignore. Practices are heading toward another year of Medicare pressure, with a proposed 2027 fee schedule that would cut the conversion factor again and reduce payment for a second service billed on the same day. For administrators already working with tight margins, the effect is not abstract. It lands in staffing decisions, appointment availability, and the daily calculation of whether a practice can keep absorbing underpayment without changing how care is delivered.
The same debate has become a familiar one, but the stakes keep climbing. Medicare payment policy, Medicare Advantage denials, and prior authorization delays now shape the tempo of routine outpatient medicine as much as clinical demand does.
Same-day payment cuts and the pushback from practice leaders
Anders Gilberg of MGMA walked through how the organization is fighting the proposed same-day cut and how practices can determine whether their physicians fall under the Ambulatory Specialty Model scheduled to begin Jan. 1. The policy mechanics matter because they influence which services are reimbursed, when claims are paid, and how much administrative work is required just to collect what was already earned through patient care.
A second service billed on the same date is common in real practice. Follow-up evaluation, problem-focused management, vaccine administration, and care coordination often occur in the same encounter stream, especially for older adults and patients with multiple chronic conditions. When payment is reduced for the second service, the result is not just lower revenue; it can quietly discourage comprehensive care, rewarding shorter, narrower visits over the kind of layered care many patients actually need.
The conference discussion also touched the end of MIPS and the Jan. 1 electronic prior authorization deadline. Those changes will not simplify practice overnight. They shift the burden from one federal reporting framework to another operational model, and practices will still need internal systems that can track requirements, verify eligibility, and prevent avoidable denials before claims leave the door.
Medicare Advantage denials and the slow bleed of downcoding
Once claims enter the payer pipeline, the financial picture often gets worse. Speakers described Medicare Advantage plans and other payers denying claims faster than practices can appeal them, a pattern that turns revenue cycle management into a constant recovery effort rather than a back-office function.
Madison Hynes discussed how hard downcoding is to track, and the problem is structural. If a payer changes the code or reduces the level of service after submission, the practice may not see a clean rejection; it may instead see a partial payment that looks routine unless someone compares billed services against remittance data line by line. The cumulative effect is predictable: more time spent chasing small losses, more accounts receivable left open, and more revenue written off after delays stretch beyond the point of practical recovery.
MGMA’s draft bill to ban automatic downcoding reflects how widespread the issue has become. Payers that automatically reduce payment without clear, individualized review force practices into a defensive posture. Every denied claim becomes a small administrative case file, and the volume alone can overwhelm staff who are already handling prior authorization, coding edits, and patient calls.
Workforce churn is now a revenue problem, not just a morale problem
The staff turnover discussion was one of the sharpest parts of the conference coverage. Rachel Brace addressed what it costs to replace an employee compared with what a retention bonus might cost, and the numbers point in one direction: letting people walk out the door is expensive. Replacing a biller, coder, or front-office employee does not stop at recruitment. It includes onboarding time, lost productivity, training gaps, and the friction that comes from losing institutional memory.
For practices, turnover has immediate clinical consequences. Longer wait times, slower phone response, and delayed claim submission all start to compound. Andrew Swanson noted the link between staffing and patient wait times, and that relationship is easy to see in daily operations. When the front desk is short-handed or the billing team is understaffed, the clinic does not simply become less efficient. It becomes harder for patients to get through the system at all.
Turnover also affects the physicians who remain. Dale Patterson, M.D., and other speakers described the contrast between “renter” and “owner” physicians, a distinction rooted in whether physicians feel they have control over the practice or are simply working inside someone else’s system. The people who stay in practices with low autonomy often absorb the emotional and operational spillover from instability around them.
One sentence from the meeting cut through the rest: when billers leave, money stops moving.
Physician compensation is rising even as visit volume falls
The conference also examined a quieter trend: physician pay rising while visits fall. On the surface, that may sound like a contradiction. In practice, it often reflects longer, more complex visits, more care coordination, and a market in which retaining physicians requires compensation changes that lag behind inflation and workload.
Swanson urged participants not to panic over one data point. Monique Delgado discussed physician-designed pay models, a reminder that compensation structures can be built around productivity, panel size, quality metrics, or a combination of those elements. The challenge is that no model solves the underlying tension between increasing clinical complexity and the time available to manage it.
Jon Dorenbos offered a different kind of intervention, speaking to physician burnout from the perspective of endurance and recovery. Burnout is not caused by one bad week. It accumulates through repeated overload, repeated administrative friction, and the sense that work is expanding faster than support.
AI scribes promise speed, but they bring legal and operational risk
Artificial intelligence came up as both a tool and a liability. Julia Rosen advised practices to start with tools they already own, a pragmatic approach in a market where many organizations are still trying to understand what ambient documentation can actually do. AI scribes can save time, but they can also create new exposure if physicians treat them as a substitute for careful review.
Tatiana Melnik addressed consent and malpractice concerns tied to AI scribes. The legal issue is straightforward: if the note carries the physician’s signature, the physician owns the documentation. AI can accelerate drafting, but it cannot own accuracy, and it cannot correct a note that misstates the history, examination, or medical decision-making. In a billing environment already vulnerable to payer scrutiny, that distinction becomes operational as well as legal.
Swanson raised the question of whether AI is replacing staff. The better answer, at least for now, is that AI is rearranging staff work. It may trim time spent on certain documentation tasks, but it does not eliminate the need for coding judgment, denial management, patient communication, or oversight of claims that payer systems continue to challenge.
What administrators were told to do next
Akash Madiah, the acting CEO, closed the practical side of the discussion with two ideas for administrators: pay close attention to the changes already coming and stay close to people who understand the work. In a year when Medicare policy, payer edits, staffing shortages, and AI implementation are all moving at once, that kind of grounded advice may be the most useful thing a practice can hear.
The conference did not present a single fix for reimbursement pressure or workforce erosion. It laid out a system in which underpayment, denials, and turnover now reinforce one another. Practices that ignore any one of those pressures will feel the others faster.
And the calendar is already moving toward the next round of changes.