How to get paid in 2025: Strategies for overcoming healthcare industry challenges
Check in with your processes and people to prevent billing errors and claim denials
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At a Glance
- With payers scrutinizing claims more closely, it’s vital to avoid errors and rework proactively.
- Consistently verify and confirm patient details, using automation to reduce the administrative burden.
- Make sure you have the right team members and processes that streamline their work, reduce repetitive tasks, and boost job satisfaction.
Costs increased throughout 2024, making getting paid fully and quickly more important than ever. Yet collecting payments remains one of the biggest challenges for medical practices and billing companies alike.
In our recent webinar, healthcare business consultant Aimee Heckman shared payment-boosting strategies from her 35+ years of experience along with Tebra’s Amanda Zeosky. The two explored the biggest challenges to collecting payments and offered tips for doing better in 2025.
Watch the full on-demand webinar, or see the highlights below.
State of the healthcare industry
These key industry challenges are affecting how practices and billing companies do business — and get paid.
Health Insurance Portability and Accountability Act (HIPAA) data breaches
Last year brought a dramatic increase in individuals affected by HIPAA data breaches. While the overall number of breaches declined from 2023 to 2024, more than 180 million patients have been affected by breaches in 2024, compared to 133 million in 2023. That spike is largely due to the Change Healthcare ransomware attack, whose downstream effects are still playing out for the entire industry.
HIPAA Right of Access
The HIPAA Right of Access initiative requires records to be released in no more than 30 calendar days (or just 15 days, in some states).
This initiative is now regularly enforced, with large fines levied in 2024. For example, the United States Department of Health and Human Services (HHS) Office for Civil Rights (OCR) announced a $100,000 penalty against a mental health center for failing to provide a patient timely access to their records.
Medicare’s 2025 final fee schedule
Starting in 2025, Medicare will pay for G2211 on claims that use Modifier 25 to report an Initial Preventive Physical Examination, Annual Wellness Visit, vaccine administration, or any Medicare Part B preventive service.
“In 2025, there will be a decrease in the conversion factor used to determine payments.”
Medicare has also added additional Caregiver Training Services codes. On the flip side, 2025 will see a decrease in the conversion factor used to determine payments.
New Consumer Protection Financial Bureau (CFPB) rule
The new CFPB rule that was proposed in June 2024 removes medical bills from consumers’ credit reports and can make collections even more difficult.
Payer challenges
Providers and billing companies (and patients) are increasingly frustrated with payers’ tactics, especially:
- Continued denials pending requests for documentation
- Continuity of Care Program denials
- Coordination of Benefits denials
- More stringent enforcement of ICD-10 coding requirements
Check out Tebra’s exclusive ICD-10 glossary, updated weekly.
Overcoming payer roadblocks
Here are strategies to surmount payer challenges.
Improve your front desk processes
A practice's front desk is the front line for getting timely, complete payments. Make sure processes involve:
- Always checking eligibility and coordination of benefits
- Verifying primary care provider (PCP) updates often
- Double-checking data entry
Doing this upfront work will reduce the pain of dealing with denials. Patient kiosks can also speed up these tasks, cutting administrative time while reducing typos or other errors.
Payer-proof your coding
To reduce automatic denials, ensure documentation is as clean and accurate as possible. Be careful with templates and carry forward of previous notes, and make sure to provide specifics on abnormal findings. Include only the relevant diagnosis codes, and avoid overusing Modifier 25.
“To reduce automatic denials, ensure documentation is as clean and accurate as possible.”
5 to-dos for a strong 2025
Here are 5 items for your 2025 to-do list.
Retain your best staff
Everyone is working overtime to keep their most valuable team members happy and avoid skyrocketing turnover costs. Beyond supporting a healthy work-life balance, check in with your staff. Are they in a role that's suited for their skillset? Are they engaged — and invested in the practice’s success? The new year is a great time to have these conversations and set goals.
Standardize policies and procedures
Clearly defined processes present a united front to patients or clients while empowering staff. Walk through processes with staff and look for ways to standardize and improve.
Maximize digital processes
Are you using all your available technology to automate routine tasks? Doing so eases your staff’s burden and leads to faster payments.
“Automating routine tasks eases your staff’s burden and leads to faster payments.”
For practices, digital intake forms reduce data entry and errors while beginning the collections process before a patient’s visit. For billing companies, robotic process automation (RPA) can automate repetitive tasks, freeing your team to focus on more complex cases.
Capture every dollar
Avoid leaving money on the table. Practices should maximize their schedule, optimize collections at every point, and be consistent with their policies and benefit verification.
Think like a business
Both practices and billing companies should shift their mindset to think like business owners. It's important to quantify results to understand what is and isn’t working, then make adjustments that better serve the business.
Effortlessly collect faster and at higher rates with Tebra’s billing and payment software.
Your year-end housekeeping tasks
Finally, follow these 5 quick to-dos:
- Conduct your regular HIPAA risk assessment
- Review your financial policy
- Note CPT code updates
- Prepare for the cost-sharing reset
- Refresh eligibility verification policies
Get all the details
Want to hear all the nitty-gritty, plus practical examples? Check out the full on-demand webinar.
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Crack the code for beating medical billing challenges with this free workbook — which provides tips around improving patient collections, streamlining claims submissions, and reducing rejections and denials.
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