Vital Signs: A July 2024 wrap-up of revenue cycle management healthcare news
Stay ahead with essential July revenue cycle management updates. Discover new revenue opportunities from the CY 2025 Medicare Physician Fee Schedule Proposed Rule and learn about updates on MIPS score previews, information blocking penalties, and loan repayment programs for physicians.
At a Glance
- CMS published its CY 2025 Medicare Physician Fee Schedule Proposed Rule with a 2.8% payment cut but introduced new revenue opportunities, including new coding and payments for various services like atherosclerotic cardiovascular disease risk assessment, additional services added to the Medicare Telehealth Services List, and 6 new MIPS Value Pathways for 2025
- HHS released a rule establishing penalties for healthcare providers engaging in information blocking — consequences include receiving a zero score in the MIPS Promoting Interoperability performance category
- CMS announced the preview period for 2023 MIPS final scores, allowing clinicians and representatives to review their scores before the release of payment adjustment information
- Effective July 1, 2024, several new remittance advice remark codes were introduced, which can help practices understand claim denials and payment delays
- A survey revealed that 89% of physicians find Medicare claims submission complex, impacting productivity and cash flow
- Ten state programs offer loan repayment options for medical students
July has been a busy month for revenue cycle management (RCM) news — especially with the publication of the CY 2025 Medicare Physician Fee Schedule Proposed Rule that includes several new revenue opportunities. Here’s a roundup of 6 newsworthy stories to share with physicians and staff in your medical practice.
1. CY 2025 Medicare Physician Fee Schedule Proposed Rule brings good and bad news
The specifics: CMS published its CY 2025 Medicare Physician Fee Schedule Proposed Rule on July 10, 2024, and with it comes a whole slew of proposed changes. The bad news? A proposed 2.8% payment cut. The good news? Several proposals that may help physicians generate additional revenue such as:
- Coding and payment for an atherosclerotic cardiovascular disease risk assessment service and risk management services.
- Coding and payment under the physician fee schedule (PFS) for a new set of Advanced Primary Care Management services.
- New coding and payment for caregiver training for direct care services and support.
- Payment for G2211 (evaluation and management [E/M] complexity add-on code) when the E/M base code is reported by the same practitioner on the same day as an annual wellness visit, vaccine administration, or any other Medicare Part B preventive service performed in the office or outpatient setting.
- Separate coding and payment under the PFS describing safety planning interventions for patients in crisis, including those with suicidal ideation or at risk of suicide or overdose.
- Several services added to the Medicare Telehealth Services List on a provisional basis, including demonstration (prior to initial use) of home International Normalized Ratio monitoring as well as caregiver training services.
- Six new Merit-Based Incentive Payment System (MIPS) Value Pathways for 2025 in ophthalmology, dermatology, gastroenterology, pulmonology, urology and surgical care.
Why it matters: As in previous years, proposed payment cuts are often offset by new payments of which medical practices may be able to take advantage.
What’s next: Read up on the changes (here’s an article that provides a great overview as well as another article outlining key proposals) to see what changes may affect your medical practice most significantly if finalized. Look for opportunities to gain revenue and begin conversations internally about how to leverage these opportunities most effectively.
2. New final rule penalizes physicians for information blocking
The specifics: HHS recently released a final rule that establishes disincentives for healthcare providers who engage in practices they knew were unreasonable and likely to interfere with, prevent, or materially discourage the access, exchange, or use of electronic health information.
Why it matters: Consequences of information blocking could be significant. A MIPS eligible clinician (including a group practice) who has committed information blocking will not be a meaningful electronic health record user during the calendar year of the performance period in which OIG refers its determination to CMS. This means they will receive a zero score in the MIPS Promoting Interoperability performance category, the score from which is typically a quarter of an individual MIPS eligible clinician’s or group’s total final score in a performance period/MIPS payment year.
What’s next: Know what does and doesn’t constitute information blocking (here’s a good resource from the American Medical Association). Also read up on additional resources, including the healthIT.gov website.
3. 2023 MIPS final scores available for preview
The specifics: CMS recently announced the beginning of the final score preview period for the MIPS 2023 performance year.
Why it matters: This is the period when clinicians, groups, and Alternative Payment Model representatives can preview their 2023 final MIPS scores before CMS releases payment adjustment information.
What’s next: Clinicians and authorized representatives of practices and alternative payment models can access the MIPS Final Score Preview by logging into the Quality Payment Program (QPP) website and clicking "Preview Final Score" on the homepage. CMS encourages clinicians to contact the QPP Service Center if they believe there’s an error with information displayed during the MIPS Final Score Preview period. The QPP Service Center is open Monday-Friday from 8am - 8pm EST at 1-866-288-8292 or by e-mail at [email protected]. To learn more about MIPS, read The Intake’s 2024 MIPS and MACRA guide.
4. Note new remittance advice remark codes
The specifics: Starting July 1, 2024, the following remittance advice remark (RARC) took effect:
- N896: Missing/incomplete/invalid trauma activation sheet
- N897: Missing/incomplete/invalid proof of member payment.
- N898: Missing/incomplete/invalid Resource Utilization Group code(s)
- N899: Missing Initial evaluation report
- N900: Missing therapy notes/report
- N901: Incomplete/Invalid therapy notes/report
- N902: Missing health risk assessment
- N903: Incomplete/invalid health risk assessment
- N904: Transportation vendor is responsible for this claim
Why it matters: The new RARC codes can provide medical practices with insights regarding claim denials and payment delays.
What’s next: Be on the lookout for these codes as you dig into the root cause of denials to promote proactive denial prevention and clean claim submission.
5. 89% of physicians say Medicare claims submission is complex
The specifics: A recent survey found that 89% of physicians found the Medicare claims submission process complex with 48% of those individuals labeling it as "moderately" or "very" complex. The survey included responses from 1,030 physicians across more than 29 specialties from Feb. 1 to March 19. Results were published July 12.
Why it matters: For many physicians, Medicare patients comprise a large portion of their patient mix, and complex claim submission can drain medical practice productivity and cashflow.
What’s next: Look for ways to streamline claim submission efficiency using artificial intelligence as well as new workflows and automation.
6. Innovative rural programs help physicians pay off their medical school debt
The specifics: A recent report identifies 10 state programs that offer loan repayment options for medical students. These states include Delaware, Iowa, Kansas, Kentucky, Louisiana, Michigan, Nebraska, New Hampshire, Oklahoma, and Texas.
Why it matters: The average medical school student in the United States takes on about $206,924 in student loans, according to the Association of Medical Colleges.
What’s next: Take a look at this report to learn more about what makes a state an ideal or challenging place to practice medicine.
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