Issue 001 · Wednesday, August 5, 2026 · 5 items + the background signal, 6 minutes
Every Wednesday we read the payer bulletins, board rulings and trade press so you don't have to, and send you the five things that actually change how you schedule, bill or hire. No fluff, no vendor spin — every figure checked against the source document rather than a headline.
This week: a federal nudge on a restorative material you may still stock, a payer-rate number that explains why a quarter of owners walked away from a network this year, a soft quarter in capital equipment that is good news if you are the one buying, and two Virginia laws that went live on July 1 while half the state was on holiday.
CMS asked every state Medicaid office to stop paying for amalgam — codes D2140 through D2161
On July 22 the Center for Medicaid and CHIP Services emailed all state Medicaid directors, urging them to restrict or end coverage for amalgam restorative codes D2140 through D2161, or else to steer volume toward resin-based composite codes D2330 through D2394. HHS Secretary Robert F. Kennedy, Jr. put it plainly in the release: "Mercury has no place in the mouths of our children or in modern American health care." CMS Administrator Dr. Mehmet Oz was quoted alongside him. The populations named as the concern are pregnant women and their babies, women trying to become pregnant, children under age six, people with neurological disease and people with impaired kidney function.
None of it binds anyone. States keep coverage authority, and the guidance concedes that "a state plan amendment is likely not necessary to effectuate this type of policy change" — which cuts both ways, because a state can move quickly without a formal amendment and can equally do nothing at all. ADA News reports amalgam accounted for roughly 8% of Medicaid restorative procedures in 2022 data, and that the Indian Health Service already decided in February to end its own use by 2027. Virginia's Cardinal Care Smiles has announced no change, and neither has Maryland or DC.
Why it matters: If Medicaid is any real share of your chair time, price the swap before somebody else decides the timing for you: composite runs longer, wants a dry field, and pays differently. Pull what your Cardinal Care Smiles schedule actually pays on D2330 through D2394 and compare it against the chair minutes.
23.5% of owners have already left an insurance network this year, with payer rates up 1.1% against 1.8% inflation
The ADA Health Policy Institute's Q2 2026 economy update, which reached the trade press in the first days of August, carries one number worth the whole report. Last winter, 35.0% of surveyed owners said they planned to drop out of some insurance networks. By the second quarter, 23.5% had actually gone and done it. Only 5.6% joined a network, against 3.2% who said they would. Every other intention came in under plan — adding staff 42.3% planned against 39.4% actual, new software 24.4% against 17.5%, major equipment 16.9% against 15.8%. Leaving a network is the single thing owners did more of than they said they would.
The arithmetic behind that behaviour is not subtle. The reimbursement index is up 19% since January 2021 while inflation ran 27% over the same stretch — an eight-point real cut — and it has not stopped: January through June of this year, rates rose 1.1% against 1.8% inflation. Equipment and supply prices are up 23% since January 2021 and staff hourly earnings up 23%, though both cooled in the first half of 2026 at 0.2% and 2.2%. The one genuinely good line is hiring: office employment was up 1.5% over twelve months as of June, the first real loosening in roughly two years, with HPI's own caution that it is "too soon for definitive conclusions to be drawn." Sample: invitations to 2,432 panel members on June 15, 589 responses, 24.3% adjusted response rate.
Why it matters: Before you drop a plan, pull twelve months of that plan's production and count how many of those patients arrived as new rather than transferred in. The average wait for a new-patient appointment is 13.9 days and 24% of owners say they are not busy enough — the network is buying you flow, and flow is what decides whether walking away works.
Scanner and CAD/CAM revenue fell 10.8% year over year at the category's biggest vendor while aligner volume grew
Align Technology reported its second quarter on July 29: total net revenues of $1,056.2 million, up 4.3% year over year. Clear aligners accounted for $870.9 million of that, up 8.2%, on 691.8 thousand case shipments, up 7.4%. The hardware told a different story. Imaging systems and CAD/CAM services — scanners and mills — came in at $185.3 million, and the release is blunt about the direction: revenues "increased 0.7% sequentially and decreased 10.8% year-over-year." Gross margin was 71.7%, operating income $154.0 million, net income $108.3 million, and full-year guidance held at 3% to 4% growth.
Read that split from the buying side of the table. Case volume is growing; sales of the capital equipment that scans for those cases are shrinking by double digits. That is what a soft market in operatory hardware looks like, and soft markets are where a buyer has leverage they do not usually get. Autumn is when the trade shows land and the year-end equipment pitch starts, and a vendor carrying a down quarter into that season is a vendor with room to move.
Why it matters: If a scanner has been sitting on your maybe list, this is the quarter to ask for the number instead of the brochure. Make them quote the trade-in, the mill, the per-case fees and the service contract as four separate lines, then take those four lines to a second vendor and let them bid.
Your assistant could legally scale in Virginia from July 1 — the training that certifies them still has no launch date
HB 970 and its identical companion SB 178 took effect on July 1, 2026 as Chapter 439. A dental assistant I or II with a minimum of 1,800 hours of clinical experience may now be certified to perform supragingival scaling and coronal polishing. The Board of Dentistry adopted Guidance Document 60-7 at its June 12 business meeting to spell out how. Certification requires at least 20 supervised full-mouth supragingival scaling procedures with patient consent, certification under oath by the supervising dentist kept in writing or electronically, and indirect supervision only. The constraint most owners have not clocked is the ceiling: "A licensed dentist shall not indirectly supervise more than two dental assistants at any given time while such dental assistants are performing supragingival scaling or coronal polishing."
Three training pathways qualify — the Virginia Dental Association curriculum delivered by a licensed dentist or hygienist, a federal program through the Indian Health Service or the military, or an existing assistant education program. The first of those does not exist yet. The VDA's June 25 update says so in capitals: "WE DO NOT HAVE A DATE FOR THE LAUNCH OF THIS PROGRAM AT THIS TIME." The next Board business meeting is September 4, 2026, which is also where criteria are expected for the companion laws SB 282 and HB 1036, covering internationally trained dentists seeking Virginia hygiene licensure.
Why it matters: Do the hours audit this month rather than in September: pull each assistant's clinical hours and work out who clears 1,800. If two of them do, you have already hit your supervision ceiling and you know exactly who to enrol. When the curriculum opens you want to be signing people up, not reconstructing timesheets.
Two Virginia laws landed on your claims desk on July 1: HB 484 on downcoding, HB 481 on who signs a denial
HB 484 — Del. Irene Shin, Chapter 1055, signed April 22, companion SB 164 — prohibits a carrier, intermediary, administrator or representative from downcoding a claim "unless the decision to downcode is determined by a person or electronic system that reflects correct coding standards and considers all relevant patient data from the billing provider in making the determination." It obliges the carrier to give the provider notice explaining the decision. And it carries the sentence with actual teeth in it: "The bill requires that all downcoding dispute decisions are reviewed and adjudicated by a natural person." No more losing an appeal to the same software that generated the edit.
HB 481 — Del. Patrick Hope, Chapter 925, signed April 13 — governs who may issue an adverse determination on prior authorisation, and the text reaches your side of the house by name: "(c) in the case of dental services, a licensed dentist if a licensed physician is unavailable." Both took effect July 1, 2026. One caveat worth knowing before you quote it at a payer: HB 484 is a general carrier statute rather than a dental-specific one, so confirm against your own plan contract that it captures your stand-alone coverage. A third bill, HB 1276 on provider good-faith estimates, did not pass and was continued to 2027 — do not build a workflow for that one yet.
Why it matters: Pick the three codes your carriers downcode most often and appeal the next one in writing, citing the notice requirement and the natural-person review by name. A statute is worth exactly what your front desk invokes and nothing more.
The fraud that empties your account arrives as an invoice you were already expecting
The FBI's Internet Crime Complaint Center published its 2025 report in April. It crossed a million complaints for the first time — 1,008,597, up from 859,532 the year before — against $20.877 billion in reported losses. Buried inside that is the line item that ought to worry a front desk more than everything else on the page: business email compromise. 24,768 complaints in 2025, after 21,442 in 2024 and 21,489 in 2023. Reported losses of $3,046,598,558, following $2,770,151,146 and $2,946,830,270.
Divide the one by the other and BEC costs roughly $123,000 per reported complaint — far and away the worst damage-per-incident of any common crime against a small business. It is not really a hack. Somebody sits quietly in an inbox, waits for a genuine invoice from your lab or your supply rep, and sends a near-identical one with different bank details. Phishing and spoofing, which is how that access usually begins, was the single largest complaint category of the year at 191,561.
The healthcare-specific picture is worse than the national headline suggests. The HHS Office for Civil Rights received 74,299 breach reports involving fewer than 500 individuals in 2024 — the category almost every independent practice falls into — up from 68,315 in 2023 and 63,966 in 2022. Email was the location in 4,373 of those small-breach reports: 6% of the reports, but 25% of the people affected. One compromised staff mailbox does more damage per incident than anything else on the list.
Business email compromise complaints reported to the FBI (complaints)
2023
21,489
2024
21,442
2025
24,768
FBI Internet Crime Complaint Center, 2023–2025 Internet Crime Reports. Counts only complaints victims chose to file with IC3, not total US incidents.
What to do about it: Tape one rule to the wall beside whoever pays your bills: no vendor's bank account, routing number or remittance address ever changes on the strength of an email. Call the number already in your records — not the one in the message — get a named person, and log the date and who confirmed it. Then switch on an external-sender tag in your mail system so a lookalike domain announces itself before anyone opens it.
Wary of AI? Start with the part nobody writes honestly about.
Module 1 of our AI for Business Growth course is free to read — no signup, no card. It covers what these tools genuinely do well and, more usefully, where they fall over. Most AI advice is either written for engineers or vague enough to be useless; this is neither.
The full course is seven modules, a fillable adoption workbook and a certificate — $149, one payment, yours for good.
Get The Practice Chair every week
Five things that actually matter, written for the people who run the business. Free, and one click to leave. Drop your details on our contact form and we'll add you to the next send.