How 831(b) plans can protect your practice from unexpected, uninsured costs

After five consecutive years of cuts, Medicare physicians can finally expect to see higher revenues in 2026. Following the passing of the One Big Beautiful Bill Act in July, Medicare physicians will observe a one-year 2.5% payment increase for 2026. This comes in addition to the reversal of a 2.83% pay cut and the temporary 2% payment increase that was applied through December 2025.

This news is welcome to practitioners who receive Medicare payments and have been impacted by inflation and other rising costs.

With higher revenues forecasted for 2026, practices should consider saving those extra funds to cover unexpected, uninsurable costs, including denied claims, reimbursement rate cuts and changes in government policies.

One way to do so is to make contributions to an 831(b) plan. This risk management tool was created by Congress in 1986 and allows businesses to set aside tax-deferred reserves to offset the impact of uninsured events, including earnings loss, government orders, business disruptions and more.

Physicians using 831(b) plans can gain peace of mind knowing they aren’t at the mercy of traditional insurers, and they can focus on what’s most important: delivering quality care to their patients.

Private practices should explore connecting with an 831(b) plan administrator who specializes in setting up and managing self-insurance options for small businesses. By leveraging 831(b) plans, plan administrators work alongside business owners to craft customized self-insurance plans that work for them and their specific needs.

One of our private practice clients shares that their 831(b) plan has complemented the recent changes to the Medicare payment structure, saying their plan “will allow their practice to stay solvent so they can continue to provide critically needed care to rural and underserved communities.”

Another example of how 831(b) plans are helping our clients stay resilient involves a national consulting firm specializing in business management services that relies heavily on government infrastructure funding for substantial portions of their revenue.

When a sudden change in public policy abruptly terminated one of their government funding streams, the firm realized it would be on the hook to remedy the loss, estimated to be about $2 million. Traditional insurance policies typically exclude losses resulting from political decisions or governmental policy shifts, leaving businesses highly vulnerable to sudden financial disruptions stemming from political actions.

The firm quickly filed a claim under SRA’s political risk policy within their 831(b) plan, and the policy provided coverage up to a limit of $600,000, significantly mitigating the financial damage incurred by the company. This immediate financial support enabled the firm to continue operations and stabilize its financial position during a critical transition period.

These are just a few examples of how 831(b) plans can keep all types of small businesses moving forward after unexpected incidents.

In the constantly evolving landscape of health care, insurance and public policy, medical professionals should have more agency when it comes to protecting and preparing their practices from the unknown. An 831(b) plan shifts that power from the insurer to the insured — back into the hands of the practice owner who leads the company, the way it is intended.

As the mainstream insurance industry remains volatile, it is up to every business leader to take the appropriate action to protect themselves, their companies, their employees and their clients. This means addressing the gaps where mainstream insurance providers fall short. Being able to self-insure can protect your practice from underinsured or uninsured unplanned events.

Doing so starts with a comprehensive, effective and affordable risk management strategy where they have the authority and ability to respond to immediate needs and impending crises. A customized 831(b) plan can help make that a reality.

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Group coaching cuts physician burnout nearly 30% in UCLA study

A randomized clinical trial at the University of California, Los Angeles (UCLA) suggests that small group coaching could be a practical way to tackle physician burnout — without breaking the bank. Researchers found that six virtual sessions, held in groups of three doctors per coach, reduced burnout by nearly 30% among internal medicine faculty. That’s more than double the reduction seen with traditional one-on-one coaching, which is typically more expensive and harder to scale.

The findings were published July 11 in the Journal of General Internal Medicine.

Led by Joshua Khalili, M.D. — who is director of physician wellness in the UCLA Department of Medicine and an assistant clinical professor of medicine at the David Geffen School of Medicine at UCLA — the randomized trial divided 79 attending physicians into three groups, with one receiving individual coaching, another receiving small group coaching and the third serving as a control group.

All coaching took place over Zoom and followed a structured program that focused on building self-awareness, setting goals and navigating workplace stress.

Participants in the small group coaching arm saw their burnout rate drop by 29.6%. The one-on-one group saw a 13.4% decrease. In the control group, burnout actually increased by 11.1% during the study period.

“This new, small-group model of professional coaching can make a significant impact in physician burnout and costs much less than the one-on-one model,” Khalili said.

Lasting effects and lower cost

Even six months after coaching ended, burnout levels stayed down for those in the small group program and continued to improve in the one-on-one group. The format — brief, virtual and focused — proved convenient enough for busy physicians to complete. Nearly all participants finished their sessions.

The price point is also a potential game-changer. Small group coaching cost $400 per physician, less than half the $1,000 price tag for one-on-one coaching. Researchers also noted benefits beyond burnout: small group participants reported feeling more in control of their workload, and individual coaching seemed to boost work-related energy.

With more than half of U.S. physicians experiencing some level of burnout and an estimated $4.6 billion in systemwide costs each year, Khalili and his colleagues say the time is ripe for broader adoption.

A model worth replicating

Notably, the small group coaching participants began with higher levels of burnout than those in the one-on-one cohort but still saw comparable relative improvements.

“By improving physicians’ well-being, engagement and sense of support, interventions like coaching can enhance the quality of care patients receive, making this a public health priority, not just a workplace issue,” Khalili said.

The coaching program is now being offered to physicians in UCLA’s Department of Medicine. Khalili and his team are encouraging other health systems to explore group-based coaching and are calling for additional studies to confirm the results across different practice environments.

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Seven steps to boost cash flow for your health care practice

Successfully managing cash flow is a primary concern for physicians as they monitor the financial wellbeing of their practice. Healthy cash flow contributes to peace of mind, supports smooth business operations, allows for expansion of services and technology, and ultimately has a positive impact on patient care. The financial health of a practice revolves around claims management. Yet with an estimated average of 15% of private payer claims denied on the first pass — and close to 17% denied for Medicare claims — practices are at risk for cash flow disruption.

In this environment, it's imperative for physicians to place a heavy emphasis on claims submissions, putting processes in place to maximize first-time clean claims.

Common reasons for claims denial and how to address them

In general, claims are typically denied due to inaccurate or missing information. This can trace back to the patient record itself, information entered during the patient encounter, or coding errors. In addition, workflows and processes the practice follows (or lacks) when it comes to claims submissions and timely follow up also contribute to claims denials.

Below are seven primary reasons that claims are denied, along with steps practices can take to avoid them:

Diagnosis mismatch to CPTs billed. This occurs when a diagnosis, the ICD code, submitted on the claim does not support the procedure or service that was billed to the insurance company. In most cases, this results from a data entry error.

Solution: Stay up to date on the latest coding protocols, and ensure data entry is clean and correct before a claim is submitted. Consider leveraging newly released AI features that may be available in your EHR. eClinicalWorks V12.0.3, for example, includes an AI assistant that can notify the physician or other clinicians involved in patient care of suspected coding errors.

Insurance rules for claim coding not followed. Insurance companies may implement specific billing guidelines that practices must adhere to when submitting a claim. Many have requirements for prior authorization, specific documentation, or specific codes for services.

Solution: Ensure that billing staff are trained on current requirements from common payers. This could involve a review of past denials and standardizing claims submission procedures for each payer based on corrected and clean claims. Or leverage your EHR to automate this function, creating rules for identifying and correcting claims before submission.

Missing referral from primary care physician. This can be confusing to navigate, as not all insurance companies require a referral to a specialist. Plus, requirements may not be consistent in terms of which specialists require a referral or not.

Solution: To avoid the risk of not receiving payment, some practices make it a rule to always require a referral. While this seems a logical stop-gap, it results in extra paperwork for the practice and headache for the patient. The better route is to rely on your EHR. Leading EHRs can prompt the physician whether a referral is needed through decision support systems, algorithms, pre-defined rules and alerts based on the patient data that’s entered into the system.

Credentialing. In order to successfully submit a claim to a payer, the physicians and other clinicians must be credentialed to ensure they meet the standards to provide care and are eligible to receive reimbursement. Without proper credentialing, claims will be denied with payments delayed.

Solution: Rely on your EHR to support the credentialing process. Most EHRs include features to automate credentialing application submission, monitor for re-credentialing timelines, and integrate with clearinghouses to streamline the process.

Lack of insurance verification. Without proper verification of a patient’s most current insurance coverage, the practice is at risk of a denied claim. A patient may have changed or terminated insurance providers leading you to bill the wrong company. A change in the patient’s coverage may also impact whether a service is eligible for reimbursement. Or a patient may have fallen behind on premiums causing insurance to lapse and resulting in a denial.

Solution: Insurance must be verified upon booking and admission for every patient. This helps ensure insurance payment for services to the practice and clarifies responsibility for the patient to avoid unexpected bills. Major EHR systems have features to automate this process, including real-time eligibility checks and integration with payer systems. If you don’t already leverage this functionality, explore the technical aspects of implementing it into your practice, along with the workflows required for successful rollout and execution.

Timely management of denied claims. Each insurance company has a very specific window of time for a practice to resubmit a denied claim. While this timeframe varies, denied claims may generally be resubmitted within six months of the original denial. Many practices lose track of denied claims (especially when they are dealing with a significant volume), which means payment for services will never be received.

Solution: Your EHR contains the power to create rules, gain visibility through financial dashboards, and set alerts for this important function. This can help keep track of denied claims and correct the errors for successful resubmission. As you work through this process, you’ll start to uncover trends in why claims are being denied. This will help you develop new procedures to avoid it on future claims. Some practices do not rework and resubmit denied claims altogether, often due to staffing strain. Always make this a priority. Remember, the goal is to minimize denied claims and reach a 90% or higher first-pass clean claims rate.

Ineffective workflows for billing and follow up. Practices experiencing a higher-than-normal denial rate typically have improper workflows for billing, which also means that following up on denied claims is difficult. That’s because of challenges accessing the necessary information to pinpoint the problem, leading to payment delays and lack of insight into the finances of the practice.

Solution: Solid workflows are critical to the financial success of your practice. They guide how your EHR is used for billing and practice management, which is responsible for key tasks, goals, and expectations for your operations. Consider the process from start to finish, beginning with the patient check-in and encounter with the physician through insurance verification, coding, and claims submission. Discover how your EHR can automate manual processes to avoid mistakes, and create a system of checks and balances to help ensure clean claims submission.

Ultimately, with these seven recommendations for RCM processes and an EHR that’s configured for financial success, practices can improve claims success rates and ensure timely payment for services rendered.

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Dos and don'ts of physician employment contract negotiations

After months of researching, exchanging emails, editing your CV and traveling across the country for interviews, the time has come: an employer has finally presented you with a formal offer and employment contract for you to sign. Chances are, you are elated by the offer and significant salary you will earn after years of receiving a pittance as a resident or fellow. However, as you read through the numerous pages full of legalese, you begin to feel a bit of anxiety. “Is this offer fair?” “What exactly does this non-compete mean?” “Is it okay to ask for more money, or will I look greedy?” “If I ask too many questions, will they be annoyed by me and rescind the offer?” These (and more!) are all normal questions most physicians find themselves asking.

Your employment agreement is the framework for your working relationship with your future employer and it is paramount that before you sign it, you feel confident that the agreement is reasonable and mutually beneficial. Understand that negotiating is an important part of the employment process. Before you dive in, however, there are a few “dos” and “don’ts” you’ll want to be aware of so that you can negotiate confidently, respectfully and effectively.

Don’t: Assume a contract is non-negotiable

Some employers may not be willing to budge on certain aspects of the contract, but remember, even in the most boiler-plate contracts, many terms remain negotiable. There are a plethora of things you can ask for in your contract so that it suits both your professional goals and your personal needs. When it comes to negotiating, it never hurts to ask for what you want! You may be pleasantly surprised by what the employer says yes to.

Don’t: Forget to do your own research

You can’t possibly know whether the compensation offered to you is fair if you don’t do any research on your own first. Try to gain a general idea of what the compensation is for your specialty and specific region of the US by utilizing online resources such as PayScale and Doximity. Or, better yet, work with an attorney or other resource that has access to reputable physician compensation data services, such as MGMA. An experienced physician employment attorney will help you to thoroughly examine the available compensation data and compare the package offered to you. Is your Total Compensation on par with what other folks are earning? What forms of compensation are available to you in addition to your Base? Is your productivity income based on Collections or wRVUs? Is the wRVU rate offered to you fair and reasonable? Further, an experienced attorney can inform you of what other financial terms your contract may be lacking that are standard, such as relocation reimbursement or a CME allowance.

Don’t: Ignore red flags

Contract negotiation can be a nerve-wracking experience and it’s normal to feel a little anxious over it. However, it’s imperative that you trust your instincts and don’t ignore any red flags. Significant red flags to be aware of include the following:

• an employer pressuring you to make a decision that feels rushed (i.e. giving you a short “deadline” to sign the Agreement).
• an employer discouraging you from consulting an attorney.
• an employer who is completely unwilling to negotiate or takes great offense to you asking questions.

Always trust your gut if things feel “off”. It’s much easier to walk away before signing than to try to get out of a contract after the fact.

Do: Be flexible but consider your non-negotiables

Understand that you may not be able to get everything you want in your contract - employers may have standard language in their contracts that they’re unwilling to budge on. For instance, what they’re offering you in terms of benefits and salary may be standard across the board for every physician new to the practice. Accordingly, you do need to be flexible on some items, but you don’t want to compromise so much that you feel you’re the one getting the raw end of the deal! Spend some time considering what your non-negotiables are. Make a list of your top priorities that you want memorialized in your employment agreement; is it a flexible schedule, the ability to hire your own NP or PA, student loan repayment, a specific location you will serve? By being prepared and knowing what you are and aren’t willing to sacrifice, the better you’ll be able to negotiate and advocate for yourself.

Do: Use an attorney to review your contract

Regardless of what an employer may tell you (e.g. “There’s no need to hire an attorney because our contracts aren’t negotiable anyway.”), or what you may hear from friends or colleagues, always consult an attorney, specifically, one who is experienced with physician employment agreements. Attorneys who are experienced in this field are the only ones who will be able to tell you what is standard, what is “normal,” what amendments are reasonable to request, what is reasonable and enforceable in terms of provisions that are specific to physicians such as Non-Compete Covenants, and so much more. Furthermore, an attorney will simply make you aware of the agreement you are entering into, which of course is contractual and therefore legally binding. Non-attorneys are not able to identify or understand the scope of potential repercussions of a contract’s terms, and therefore don’t know how to protect themselves. While you are incredibly educated and capable, remember that you don’t know contracts! And perhaps most importantly, keep in mind that the contract you are being offered was written by an attorney (or team of attorneys) who represent only the employer and therefore are bound to promote their client’s best interests, not yours. It only makes sense to have the same level of protection and guidance in this process.

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3 proven ways to prepare your practice for the winter patient surge

The winter wave is upon us. Colds, flu and respiratory illnesses spread as cold weather keeps people indoors, and large groups congregate for holiday celebrations. These issues, decorating injuries, hypothermia and other challenges also lead to a surge in emergency room visits.

That keeps physicians’ offices, clinics and hospitals awash in appointment requests and patient arrivals. The rush of patients and paperwork just as staff head out for the holidays, and call in sick with greater frequency, creates a perfect storm – often overwhelming staff with a flood of administrative tasks; intensifying already widespread scheduling gaps, slow claims processing and compliance issues; and forcing doctors to tread water for hours, days, weeks or months.

Here are three ways to stay afloat during the winter wave and optimize operations all year long.

1. Think about what’s at stake

Three-fourths of medical practices cite scheduling gaps, slow claims processing and compliance administration as their biggest operational pain points, according to our 2025 Medical Staffing Trends Unveiled report. These are the exact high-pressure zones that intensify during the winter wave – leading to appointment delays, overextended providers and ER bottlenecks.

This adds up to extra hours for administrative staff and costly overtime for the practice. Doctors often lend a hand with administrative tasks when they see that stretched staff are struggling to keep up. But that can extend doctors’ days by hours, adding stress that may make doctors themselves more likely to get sick. Ultimately, some doctors may even decide to look for career opportunities at properly staffed medical facilities that allow them to focus on treating patients.

Despite the group efforts that often go into addressing ballooning administrative tasks, many medical facilities are still unable to schedule patient appointments quickly and efficiently. As a result, patients may become frustrated and go elsewhere. The inability to schedule and bill in a timely manner can also make it challenging for practices to afford office overhead and grow.

2. Identify where your shortages are

Rather than assuming doctors and staff can pick up the slack if you are short by one or more team members during the winter wave, the reality is that it could be quite painful – for your administrative staff, your doctors, your practice’s health and the patients you keep waiting.

Assess staffing by polling your administrative team and managers to understand where they are. Think about the extent to which doctors are or will feel the need to help with such tasks at a time in which Stanford Medicine says U.S. physician burnout rates remain “worryingly high.”

Be open to new ways of addressing administrative tasks. Local hiring is not always the answer.

3. Rethink what remote really means

The solution to winter staffing challenges isn’t simply going remote, it’s going flexible. Today’s leading practices are adopting workforce platforms that connect them to certified, compliant administrative talent — supported by secure systems, continuous training, and real-time oversight.

It’s not about outsourcing tasks; it’s about integrating global, high-performing teams into your operations with the same compliance, technology, and accountability you’d expect in-house.

That means your practice can scale faster, maintain HIPAA standards, and keep patient experience seamless — even during the busiest months of the year. Now you can provide the best experiences for your patients, staff and doctors – and turn seasonal staffing pressure into a year-round operational advantage.

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Putting fun in the medical practice: Hire for attitude, train for skills

Incorporating humor in health care hiring can enhance workplace morale, creativity and patient care; creating a more enjoyable environment.


"Fun is taken seriously at Southwest Airlines. Life is too short and too hard and too serious not to be humorous about it." Herb Kelleher, founder of Southwest Airlines

Healthcare is a stressful occupation. Most doctors and healthcare employees are having to work smarter, harder, and faster than ever before. Is it any wonder that burnout affects more than 50% of healthcare workers? As the pace and intensity of healthcare have increased, we often lose touch with the lighter side of life and question why we entered the profession in the first place. Many medical practices have become very serious and businesslike, and we are requested to leave our personal and emotional baggage at the door before entering the office. We have been told that humor in the workplace is unprofessional and that silliness is for children's play.

Southwest Airlines believes that failure to nourish and encourage a sense of humor in the workplace not only undermines productivity, creativity, adaptability, and morale, but also can drive employees to quit, resulting in costly turnover.

Southwest Airlines seeks employees, including baggage handlers and pilots, who can perform their jobs with humor and professionalism. A passenger on a Southwest Airlines plane hires employees who are uninhibited and empathetic, believing that serving customers, which includes a sense of humor, makes the lives of both employees and passengers more enjoyable. I think that healthcare must move beyond the traditional mold of a serious, stiff, and humorless atmosphere and incorporate appropriate levity when providing care to our patients. We need to shift gears and find ways to make work in healthcare fun despite the intensity and seriousness of our profession.

How to find those potential new hires that have a funny bone as well as a crazy bone. We need to follow the example of the hiring process at Southwest Airlines, which is hire for attitude and train for skills. Their HR department looks for employees who don't take themselves too seriously and then commits to training them on what they need to do for the passengers and the airline. They focus on hiring employees with the right spirit. They look for potential employees with other-oriented, outgoing personalities, individuals who are willing to work hard and have fun at the same time.

Perhaps when interviewing a potential employee for the first time, you might ask, "Tell me how you used your sense of humor in a work environment or tell me how you have used humor to defuse a difficult situation." Let's assume you are looking for a new associate with an impressive resume and skills that could be a valuable addition to the practice. If the potential employee is stiff, reserved, inhibited, and lacks good communication skills, that may be a red flag indicating that this employee might not be a good fit for the practice. This might be a difficult choice, but it would be far better to pass on such an employee and continue the search. Although such a candidate might be qualified on the technical side, they would be deficient on the attitude component.

When posting a job opening, you might include in the job description that "if you are looking for those who are outgoing, even a bit off-center, and like to color outside lines, then you will enjoy working in this practice." You might continue your new-hire post by stating, "Consider Acme Healthcare if you want a future without boundaries, the opportunity to be original, and a chance to work your tail off!" This kind of post emphasizes that your practice is a serious medical practice that is committed to providing outstanding care to patients, while also prioritizing fun, financial responsibility, and a down-to-earth atmosphere. With this kind of word-of-mouth plus social media, the message is clear, and you are likely to have the right type of applicant flocking to your practice. I am not suggesting that you are looking for stand-up comedians or those who can dole out one-liners. However, the message is clear that behind all the fun, there's a lot of hard work.

Bottom line:

Consider looking for future employees with a sense of humor. I want to emphasize that you hire for spirit, spunk, and enthusiasm, and you can follow up and train for skills. When you have such an employee, treat them as family members or best friends. Don't ever take them for granted. Finally, treat everyone — patients and employees — with kindness and respect. They will appreciate the kindness and pass it on to your patients. As a result, you will have an enjoyable practice that is both productive and efficient, and fun.

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ACA premiums signal new pressures on providers: How to prepare

Providers certainly do not need any new financial pressures. Unfortunately, they are coming.

Insurance provided through the Affordable Care Act (ACA) marketplace is expected to increase by 26% for 2026 plans—the largest rate hike since its launch. That’s the average. In the 32 states using Healthcare.gov, those premiums are expected to rise upwards of 30%. Even worse, some enrollees could see their premium payments more than double if the enhanced premium tax credits expire at the end of 2025.

Bottom line: the cost of care is going to dramatically increase for many, and patients will be taking on more payment responsibility. At a time when copays account for the highest percentage of bad debt for healthcare organizations, providers must get out in front of the patient collection challenge by implementing five key strategies for their ACA-insured patients.

1. Map the new patient journey early

Traditional billing practices lack patient empathy and are notorious for creating confusion and frustration. In contrast, a patient-centric approach ensures financial clarity and transparency at every stage of the patient journey.

The changes coming for those insured in the ACA marketplace will likely result in unwanted financial surprises. Providers should acknowledge this up front and treat these enrollees as a distinct group that needs special attention. Then they can implement proactive strategies that prioritize clear communication around coverage limits and cost expectations.

2. Segment and communicate proactively

With higher out-of-pocket costs coming, price transparency and the ability to provide accurate estimates upfront will be more important than ever. Providers need tools that will support segmentation of those currently insured in the ACA marketplace and those newly insured, as well as timely means of communicating financial responsibility and payment options.

Automation plays a key role in the effectiveness of these strategies as manual processes are often a non-starter in today’s leanly staffed provider organizations. Any communication method should meet patients where they are, addressing both education level and native language, as well as making information available in a variety of formats, whether text-based, email or phone.

Once patients receive notification of copay estimates, staff readiness is essential. Patients will look to them to discuss payment options including payment plans or financial assistance that may be available. The reality is that patients are much more likely to follow through with payment if they understand their financial obligations and options.

3. Go digital with payments and billing

Digital payment innovation is one of the most effective ways to improve collection rates and speed revenue cycle because it helps eliminate confusion. Given that the majority of consumers prefer digital billing and payment options, providers should invest in tools such as mobile statements, text reminders and online payment plans to improve both collection rates and patient satisfaction. The good news is that when patients opt for digital communications, providers win on the operations front, both in terms of more efficient use of staff time and the costs associated with generating and mailing paper bills.

While digital offerings are important, patient preference should remain at the forefront of strategy. Consequently, digital tools may need to coexist with paper statements and payment. They key is to incorporate patients’ preferences into communications by asking them early in their financial journey how they would like to be notified about their balance.

4. Automate to protect cash flow

Shoring up reconciliation processes will be critical to staying ahead of increased patient financial responsibility. Deploying reconciliation and payment-acceleration tools to reduce days in A/R and streamline back-office work is an important step forward. When payment reconciliation is automated, providers can match incoming electronic payments to invoices to improve accuracy and speed processes.

Equally important are advanced platforms that reconcile both payer-collected and direct patient payments. While patients are increasingly looking to easy payment options such as insurance portals and health savings accounts (HSAs) to make their copays, provider organizations often have to wait weeks to receive funds. Automation ensures these payments are transferred immediately to a provider’s bank and reconciled within existing provider systems, as opposed to receiving a check or virtual card outside of the EHR.

5. Reevaluate collection policies

Rising out-of-pocket costs demand new approaches to outdated, manual billing processes that lack patient empathy and engagement. Sustainable financial health now depends on meeting patients where they are via flexible payment options, early-out strategies and clearer financial education. When patients have clarity at every step of their financial journey, providers can foster trust, improve outcomes and build loyalty.

Many patients may be caught off guard by coming increases associated with ACA premiums. Providers who acknowledge that increased financial pain and take action will be best positioned to help patients navigate changes as well as collect balances owed. From transparency into pricing and copays to personalized communications and flexible payment options, the future of patient-centric billing will prioritize educating, engaging and empowering patients.

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