Medicaid is a lifeline for roughly 84.5 million people across the U.S., yet access to that safety net still depends on state lines. Ten states—Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming—continue to reject the Affordable Care Act (ACA) expansion, leaving an estimated 1.4 million adults in the infamous coverage gap. This category includes individuals whose earnings are too high for traditional Medicaid but still below the poverty level that qualifies them for Marketplace subsidies.
Now, both the House and Senate have passed budget reconciliation bills with provisions that aim to reshape the Medicaid landscape. While the two chambers still need to reconcile their differences before final enactment, the changes will likely have two significant implications for healthcare providers. One, a surge of newly insured patients walking through their doors, and two, stricter rules for getting paid. While the final bill and exact implementation timelines are still being finalized, providers can—and should—start preparing now.
Shore Up Your Revenue Cycle Before Denials Spike
When new legislation is implemented, the first sign of trouble is often a sudden spike in claim denials. It’s not random; it’s the result of a delay between the new policy going into effect and practices fully adjusting their workflows. For example, a billing team may attempt to use codes that were working previously but now require a new modifier. Or a service that never needed prior authorization suddenly does, so the claim is submitted and instantly rejected.
If a payor updates what they consider “medically necessary,” information that used to justify a service or procedure might now fall short simply because it’s missing a few key phrases. These errors accumulate quickly, especially if the billing software hasn’t been updated yet. Just one change can lead to a string of denials that could have been avoided with proper preparation.
There are practical ways to stay ahead:
- Start by verifying insurance eligibility as soon as a patient calls to schedule an appointment.
- Real-time eligibility checks give your team a few days to correct bad information or flag missing authorizations, saving everyone from a denied claim later.
- Use software that scrubs claims for common issues before they’re sent out, and track every rejection in a simple log so you can spot new patterns quickly.
- Take a moment now to review and update your most frequently used codes and refresh prompts for documenting medical necessity. It’ll be a lot easier than reworking dozens of denied claims afterward.
Integrate Your Tools So Data Moves Without Duplicate Admin Work
It’s possible to get by with disconnected systems, but as soon as the schedule ramps up, problems will become clear. When staff have to jump between disparate EHR, patient portal, and billing systems just to process a single patient, everything slows down. Plus, each extra step increases the risk of mistakes and consumes time and attention that could be spent helping someone face-to-face. Over time, this kind of inefficiency can lead to increased burnout.
The best way to fix it is by tracing the patient’s path. Begin with an individual appointment and follow the patient through the scheduling, intake, billing, and payment processes. Take note of every point where someone has to retype or copy information; those are the spots that need to be connected.
Once systems share data seamlessly and automatically—such as patient demographics, insurance details, or appointment status—staff don’t have to repeat the same work. It reduces the risk of errors and helps everyone move faster, especially when things get busy. Clean handoffs between systems mean fewer headaches for the team and a smoother experience for patients.
Stress-Test Workflows Before the Policy Clock Starts
The moment a final rule is posted, the clock starts and the margin for delay shrinks fast. Teams that wait for full clarity will often have to react under pressure. Instead, the focus should shift now to build readiness into day-to-day operations: test systems early, stress-check documentation, and tighten feedback loops well before a deadline hits.
If possible, duplicate your live, in-production database in a test environment and then add the volume of extra Medicaid visits you expect after expansion. Track how eligibility calls, note templates, and claim batches behave under load. If authorization queues cause delays or template prompts miss required fields, you can revise while the stakes remain low.
It also helps to audit high-volume services to make sure documentation aligns with current audit standards. Well-built templates act as scaffolding—it’s much easier to tweak them than rebuild under a tight schedule. And none of this works without a fast feedback loop. Quick, regular updates between clinical and billing staff catch issues early and keep teams aligned. Quarterly memos often land too late, while short, timely communication and early rehearsal can make the difference between rushing toward compliance and arriving ready.
Invest in People, Not Just Software Licenses
Policy changes are stressful, especially when teams don’t feel supported. The biggest sources of anxiety tend to be clunky technology and unclear communication, both of which can be addressed with the right approach. A strong people-first strategy makes room for honest conversations with staff, better tools used more effectively, and ongoing training at the right time.
Training is a great start, but it has to provide value. Long webinars and thick manuals don’t align with how people work day-to-day. Short, digestible resources like step-by-step walkthrough videos are far more effective. They meet staff where they are and show exactly how new tools or processes fit into the real, holistic workflow. The goal isn’t just to inform but to reduce friction and build confidence with every update.
Communication has to follow the same principle. When payor rules shift, the update should be shared immediately—even if every detail isn’t final. Early, transparent messaging will set the right tone: leadership is paying attention and preparing alongside the team. This kind of clarity—combined with user-friendly technology and practical training and support—helps staff stay grounded. Over time, it builds a culture that adapts to change without burning out in the process.
Readiness Outperforms Certainty, Every Time
Federal guidance often arrives in phases and rarely with sufficient time to prepare fully. While stable reimbursement would make planning easier, grace periods don’t leave room to rebuild operations from the ground up. That’s why readiness should be built in: practices that focus on consistent execution—tight eligibility checks, connected systems, volume testing, and timely team updates—are better prepared to adjust on the fly, without losing momentum. These aren’t massive changes; they’re repeatable routines that help practices stay aligned even when policies aren’t.
About Vidisha Pulaguru Srikanth
Vidisha Pulaguru Srikanth is a Senior Product Manager, Practice Management at RXNT. She has been in the health tech industry for more than 5 years, helping healthcare organizations and billing companies develop efficient workflows. She’s passionate about giving healthcare professionals the tools to successfully navigate complex challenges in medical billing and revenue cycle management.
