8 in 10 ENTs say Medicare’s proposed same-day payment cut could reduce seniors’ access to care. Here’s how to protect your revenue.

The proposed 2027 Medicare cuts have ENT practices worried about more than their bottom lines. In a survey of more than 1,400 otolaryngologists, 80% said proposed cuts to same-day care could reduce seniors’ access to treatment. Another 67% said they would see fewer Medicare patients, while 14% said they would stop accepting Medicare altogether. 

Those concerns come as CMS projects a 9% reduction in ENT payments from changes to how Medicare values services, tied with dermatology for the largest proposed cut of any specialty. And that’s before factoring in a separate reduction to Medicare’s payment conversion factor. The changes, first proposed in July, could take effect as soon as January 1, 2027, with a final rule expected in early November. 

While these cuts are largely outside a practice’s control, the operational factors that determine how much revenue you actually capture are not. In this third installment of our specialty-by-specialty series, we’ll break down what the proposed cuts mean for ENT practices and what they can do now to protect revenue. 

What CMS is proposing for 2027 

The proposed 2027 Medicare changes could affect ENT practices in a few different ways. Here’s a closer look at three of the biggest changes.

1. A 50% payment reduction for certain same-day services

ENT providers frequently perform diagnostic procedures during routine office visits, such as using a scope to examine a patient’s nasal passages or throat. Under CMS’s proposal, these appointments could become less financially sustainable. 

When a separately billable office visit and a qualifying procedure take place on the same day, Medicare would reimburse the higher-priced service at its usual rate but cut payment for the other service in half. The reduction would apply to services performed by the same physician or physicians in the same practice, even when both services are medically necessary and properly documented. 

CMS is considering a smaller, 25% reduction as an alternative. It floated a similar policy in 2019 but ultimately chose not to implement it.

2. Changes to how Medicare calculates practice expenses

Running an ENT practice comes with plenty of overhead, including exam rooms, specialized equipment and the staff who keep everything running. Medicare factors these expenses into how much it pays for different services. 

Now, CMS wants to change that calculation. The proposal would gradually eliminate an adjustment used to estimate indirect practice expenses, removing half in 2027 and the rest in 2028. It would also change how those costs are spread across different services. 

The AAO-HNS has raised concerns that these changes could hit office-based ENT practices particularly hard, given the equipment, supplies and staff needed to provide care. 

3. A lower Medicare conversion factor

Medicare uses something called a conversion factor to help determine how much it pays physicians for their services. Think of it as the dollar amount that turns a service’s assigned value into an actual payment. 

CMS proposes lowering that factor from $33.4009 to $32.8409, a 1.68% decrease, for clinicians who don’t qualify for certain alternative payment models. According to the AAO-HNS, most otolaryngologists fall into this group. 

That means ENT practices could face a lower conversion factor on top of the other proposed payment reductions. Exactly how much reimbursement changes will depend on the final rule, expected in early November. 

Why ENT faces outsized exposure 

ENT is tied with dermatology for the largest proposed Medicare payment reduction of any specialty in 2027. According to CMS, otolaryngology payments could fall by 9% from changes to how Medicare values services alone, before factoring in the lower conversion factor. 

A major reason is how ENT care is delivered: Patients often receive an evaluation and an in-office procedure in the same appointment. For example, someone with symptoms of head or neck cancer might undergo a scope during their initial visit to help determine the next steps without scheduling another appointment. 

The proposed same-day payment reduction would affect these visits, even when both services are medically necessary. And the concern goes beyond reimbursement: Delaying a procedure until a separate appointment could mean additional travel, costs and anxiety for patients. 

The financial impact could be even greater for ENT groups that offer audiology or speech-language pathology services. According to the American Speech-Language-Hearing Association (ASHA), the proposed changes could reduce overall Medicare payments for audiologists by about 3%, while changes to practice expense calculations could lower reimbursement for many audiology and speech-language pathology services by roughly 5%. On top of that, a commonly used speech-language therapy billing code (CPT 92507) will be replaced by 10 new time-based codes in 2027, requiring practices to adjust how they document and bill for care. 

The impact might not stop with Medicare, either—private insurers could adopt similar policies. For instance, Horizon Blue Cross Blue Shield of New Jersey announced plans to cut payments by 50% for certain office visits billed alongside procedures in 2022. If more insurers follow Medicare’s lead, ENT practices could feel the effects. 

All of this comes at a time when reimbursement is already struggling to keep pace with rising costs. According to the American Medical Association, Medicare physician payments have fallen 33% since 2001, after adjusting for inflation in practice costs. Additional cuts could put even more pressure on ENT practices trying to maintain patient access while managing their expenses. 

5 operational levers practices can pull now 

Fortunately, there’s plenty that ENT practices can do now to strengthen their finances. Here are five places to start: 

1. Make collecting payments part of the visit: Don’t wait until after an appointment to collect money that’s already due. Give patients opportunities to pay copays, outstanding balances and other costs during pre-registration or check-in. The easier it is to collect at the time of service, the less time staff need to spend tracking down payments later.  
2. Get ahead of insurance and authorization issues: In-office procedures can be costly to deliver, especially if the claim is later denied because of a preventable coverage issue. Check insurance eligibility, benefits, referrals and prior authorization requirements before patients arrive. This is particularly useful for ENT groups coordinating care across multiple services, where coverage requirements may differ for physician visits, hearing tests and speech-language therapy. 
3. Get more out of the schedule you already have: An empty appointment slot represents time and resources a practice can’t get back. Automated reminders, online rescheduling and smart waitlists can all help fill cancellations and reduce no-shows without putting more work on the front desk. These tools may become even more valuable if same-day reimbursement changes create additional scheduling demands.  
4. Spend less staff time on routine tasks: Each step of an ENT appointment takes time, and those minutes add up across a busy practice. Giving patients more ways to complete routine tasks themselves, while automating appropriate behind-the-scenes work, can help teams manage more appointments without a corresponding increase in administrative costs. 
5. Help patients understand what they’ll owe: ENT visits can involve multiple services, sometimes during the same appointment. That can make bills confusing, particularly when patients aren’t sure how their insurance covers an evaluation versus a procedure. Providing cost estimates when available, explaining financial responsibilities and making payment options clear can reduce surprises and billing-related calls. It also helps practices collect payments sooner. 

What high-performing ENT practices are already doing 

Some ENT practices are already using Phreesia to bring in more revenue without adding to their workload. In fact, 1 in 6 ENT patient visits starts with Phreesia. And the best-performing ENT practices using the platform are seeing measurable improvements, such as: 

• 7x more payments collected, with 92% of patients paying copays at the time of service 
• 86% of scheduled payments result in successful collection 
• 78% fewer no-shows, helping practices make better use of available appointments 
• 85% of patients checking themselves in, reducing the work required at the front desk 
• 87% fewer calls and 80% of calls handled without staff involvement via VoiceAI, giving staff more time to focus on patients who need their help 
• 8+ minutes of staff time saved per self-scheduling patient 

Scotch Institute of Ear, Nose & Throat (SIENT), a six-provider ENT group in the Tampa Bay area, provides a closer look at what these improvements can mean in practice. 

After adopting PhreesiaOnCall to manage after-hours patient calls, SIENT was able to: 

• Triage 150 calls 
• Reclaim 37 hours of staff time  
• Save $3,600 
• Achieve a 91 Net Promoter Score 

“I like logging in every morning, seeing what calls came in and making sure they were all addressed,” said Jodi Scotch, the practice’s administrator. “Now, I don’t have to bother [providers]. I can see on the dashboard that they responded. Nothing gets lost anymore.” 

Conclusion

The proposed 2027 Medicare cuts could put significant pressure on ENT practices, but reimbursement rates are only part of the financial picture. How much revenue practices actually collect—and how efficiently they manage each appointment—will also shape their bottom lines. Practices that close the gap between what they’re owed and what they collect will be better positioned to weather the changes.