Insights

June 2026

Why Your Front Desk Shouldn't Be Doing Your Billing

It’s 10:06 AM on Friday and you’ve already auto-posted and reviewed all the payments for the day, submitted one corrected claim and another for reprocessing, sent an e-mail to the payer about your provider’s credentialing application, and audited the last few days’ new claims for submission. You’re on a roll and ready to move on to your next task - correcting errors found on the audit - when a prospective patient walks in requesting information about the practice. Suddenly, it’s after lunch and you still haven’t prepped the new claims for submission. This means that now, the claims won’t get through the clearinghouse to the payers until Monday, delaying payment by three days or more. You field several phone calls that afternoon and because the electrician is coming in at 2:00, you’ll need to escort him around the building, and also won’t get to complete the authorization review you needed to do today. Your supervisor - the office manager - isn’t able to help pick up any of these tasks because she’s at a conference. Even when she’s at the office, billing responsibilities make up a small portion of her job description and she’s usually handling pressing HR matters.

Chaotic, right? This is the everyday life for anyone who is billing while managing the front desk of a clinic. The admin department at a healthcare practice is often underfunded and undervalued, leading to poor performance, high turnover rates, and most importantly for the practice owner: revenue loss. Medical billing and payer relations are highly specialized skills, and do not realistically fit well within a scope that also includes things like payroll, customer service, or general office management. This would be similar to expecting a biology teacher to also be able to effectively teach classes in art and calculus; they might all be classes in the same grade level on the same hallway, but their complexity and niche skills require differently trained staff. Not to mention the time-intensive nature of medical billing. 

This is the case even if it’s a small practice. Especially if it’s a small practice, because one billing mistake can cost the company a huge portion of its revenue. Because the claims in the example above weren’t submitted on the day they usually should have been, payments won’t come in by the expected date and could delay payroll. Errors will become more frequent given the nature of the biller’s work environment and the pressure to submit by the deadline. The decision to have your admin staff wear all the hats can be easily tied to real revenue loss and risk - whether the consequences come now, or later during an audit.

The solution is simple: hire a designated biller, or outsource. The use of AI is great as a supplement, but you’ll still need staff with a thorough understanding of billing and coding guidelines, payer policies, and appeal strategies—and the uninterrupted time to manage it. There are countless qualified billers available at reasonable rates. By committing sufficient resources to your billing process, you protect your revenue cycle, stop overworking your front desk, and ensure your practice actually gets paid reliably for the care it provides.

May 2026

The Shifting Landscape of ABA

The ABA field is undergoing massive change - over the last several years, private equity investment flooded the industry, telehealth expanded, and state Medicaid budgets saw unprecedented growth in autism and related therapy spending. Now, lawmakers and health departments are pushing back. Their goal is to rein in costs, combat fraud, and enforce stricter clinical quality standards. While these changes are happening nationwide, North Carolina has suddenly undergone aggressive ABA regulations. If you operate an ABA practice in North Carolina, or work as a remote clinician for a company based there, the landscape looks entirely different today than it did just a few months ago.

To understand the sudden shift, the numbers help to explain it - according to data from the North Carolina Department of Health and Human Services, state and federal Medicaid spending on ABA therapy skyrocketed from $1.9 million in 2020 to over $505 million in 2025¹. This jump in spending outpaced the rate of new autism diagnoses and lawmakers began to suspect providers of potential fraud, waste, and abuse, specifically those that are private-equity-backed using heavy telehealth models.

Under the latest rules, North Carolina has banned out-of-state providers from Medicaid reimbursement unless they live within 40 miles of the state border. Further, telehealth behavior analysis is restricted entirely in non-rural counties. Additionally, the state is standardizing stricter requirements for Registered Behavior Technicians and parent participation. Companies are having to respond by filling sudden vacancies and restructuring compensation packages, families are adjusting how they receive therapy, and the administrative burden is increasing on everyone.

This is not just an isolated event; we can expect significant changes to ABA in the coming years, especially in response to massive federal budget cuts. The era of huge, high-margin, private-equity ABA companies may be coming to an end, but high-quality, smaller providers are also facing the brunt of these decisions. These providers could be inundated with demand, creating a scenario where there are even less ABA providers to service a growing population, an issue which is proven to drain resources elsewhere - often on the taxpayer’s dime. Navigating this transition successfully demands both administrative competence and a deep commitment to individualized, ethical care, and the companies navigating these changes right now could be setting the precedent for how the industry operates in the future.

¹https://www.northcarolinahealthnews.org/2026/04/27/autism-therapy-costs/#:~:text=While%20parents%20describe%20the%20therapy,million%20just%20five%20years%20earlier.&text=Costs%20are%20projected%20to%20exceed,mostly%20children%20%2D%2D%20with%20autism.

April 2026

Using AI in Healthcare: Balancing Innovation with Integrity

The conversation around AI in healthcare is starting to shift. Professionals in all sectors are having to contend with, and embrace, its usefulness. Recently, Anthem sent a memo out to its providers about the use of AI in their work (found here). This included some reminders about patient privacy, using approved tools, and maintaining clinical integrity. Other entities, like the states of California and Texas, are developing their own policies specifically targeting the use of AI by medical professionals. It may seem obvious to most providers that relying on AI to develop treatment plans and make clinical decisions, like diagnoses, is wrong. But - this is just one example of the many areas where the use of this tool will require significant oversight.

Another example is in billing and auditing. When the boom of AI started, countless AI companies started offering progress note and claim auditing services. The EHRs currently used by providers began their own integration of AI, going as far as to essentially ban the use of outside companies. These services began to extend further to billing for the provider; I’ve even seen advertisements for an AI product that claims to call the insurance company on your behalf. There was - and still is - an inundation of solicitation and promises of new technology that will decrease your administrative bloat and improve your processes. Along with it came some serious concerns about the ethics surrounding AI, and its compatibility with current practices.

The ubiquity of AI is not slowing down. We are seeing it everywhere, even when we don’t realize it. Most of your doctors probably use it in some capacity. When used correctly, it can reduce administrative bloat. But, there are some important considerations in its implementation. 

First, AI is not a human. This might seem obvious, but we can’t forget it. Things that might occur to us when doing our work - cultural considerations, brand new updates to practices, and other nuances - are not effectively built into the AI algorithm. 

Second, privacy. A lot of us have probably logged on to a Zoom meeting only to see an alert saying “This meeting is being transcribed by an AI participant” (or something to that effect). Imagine that - but it’s your doctor’s appointment. Even in billing, AI is perusing every detail of the services you’re providing to patients - including their name and all of their demographic information.

Third, like humans, AI is not perfect. A reliance on the product can lead to some pretty egregious errors if not properly managed. Not everyone is technologically-savvy enough to oversee the appropriate integration of AI, opening the door for some pretty big mistakes to occur.

The takeaway of the current status of AI should be that it’s a great tool, but still requires some pretty substantial human oversight. Providers and their admin teams should not be waiting on memos from the insurance companies to make these types of adjustments. There needs to be a proactive effort to make sure that all of the factors listed above are weighed when deciding on an AI product. This is not an exhaustive list, and having the right professionals behind AI implementation will have the greatest influence over its success.

March 2026

How the expiration of enhanced ACA subsidies may impact American families' access to ABA therapy

In December 2025, enhanced Affordable Care Act (ACA) subsidies in the United States ended, putting millions of people’s access to affordable healthcare coverage at risk. Not only did this increase healthcare premiums for those who lost their subsidies, but it also increased premiums across the board - both for marketplace plans and private plans alike. Many saw increases of 20% or more¹. Combined with rapidly increasing cost of living expenses, access to healthcare has suddenly become out of reach for many families. Many of these families are already facing challenging health burdens like chronic illnesses and systemic health disparities. Some families are navigating mental health diagnoses for their children, treatment for which can cost thousands of dollars per year with insurance, and tens of thousands without.

While Applied Behavior Analysis (ABA) remains the subject of debate in some circles, there is substantial evidence that the therapy contributes to significant gains in areas like academic readiness and language². Further, current resources available to families with children with mental health diagnoses are severely lacking relative to the amount of need. I couldn’t tell you the number of times that I’ve spoken with a parent who was either at risk of losing their job, or already had, because their child was forced to leave their daycare. Parents working from home with their child with high needs, simply because there was no other option. Even for parents who know of the available resources, waitlists are just as effective a barrier.

For a lot of these families, ABA is a lifeline. I’ve seen kids gain language who may otherwise have not. Kids who are able to be around their peers and learn enough independence to let their parents attend to other siblings or go grocery shopping. Most of these families are not high-income and depend on affordable healthcare to give their children these opportunities. Going from Gold-level Marketplace plans with subsidized premiums, lower copays, and access to more providers, to lower-level plans or no insurance at all will cause a lot of children to lose ABA therapy. A significant portion of ABA providers require a certain number of hours per week in order to support progress, meaning parents cannot necessarily choose a lighter schedule to save on costs. Any disruption in regular treatment can cause immediate and lasting regression³.

Therapies like ABA, talk therapy, speech therapy, social skills groups, and many more are especially at risk because of their frequency of care. For the best outcomes, these therapies need consistent appointments, unlike services like primary care or specialists, who often only see a patient a handful of times a year. Associated costs for these therapies can be insurmountable, but their services and therapists are an integral part of these families’ lives. The reestablishment and permanent status of enhanced ACA subsidies is one step toward closing this gap in care. Even more so, our communities’ high-needs children and their parents need better wrap-around resources that do not pose such a strain on their pockets. 

The promise of health equity does not have to be a theory, and ensuring a child’s ability to communicate or gain independence should not be dictated by the expiration of a tax credit. Our community’s children are full of potential, and by advocating for the resources and subsidies they need, we are investing in a more equitable and vibrant future.

Works Cited

¹Holahan, J., & O’Brien, C. (2026, January). Putting the Extraordinary Increase in ACA Premiums in 2026 in Perspective. https://www.commonwealthfund.org/blog/2026/putting-extraordinary-increase-aca-premiums-2026-perspective#:~:text=A%20new%20Urban%20Institute%20report,the%20employer%2Dsponsored%20insurance%20market

²Makrygianni, M.K., Gena, A., Katoudi, S., Galanis, P. (2018). The effectiveness of applied behavior analytic interventions for children with Autism Spectrum Disorder: A meta-analytic study. Research in Autism Spectrum Disorders, Volume 51, Pages 18-31. ISSN 1750-9467.

³Choi, K.R., Bhakta, B., Knight, E.A., Becerra-Culqui, T.A., Gahre, T.L., Zima, B., Coleman, K.J. (2022). Patient Outcomes After Applied Behavior Analysis for Autism Spectrum Disorder. J Dev Behav Pediatr. 43(1):9-16. doi: 10.1097/DBP.0000000000000995.