Vital Signs: A September 2024 wrap-up of revenue cycle management healthcare news

Welcome to “Vital Signs,” your go-to monthly roundup of all things related to RCM tailored specifically for independent practices. Access previous editions for the top insights and developments here.

As always, it has been a busy month for revenue cycle management (RCM) with important developments related to 2025 CPT codes, denials for preventive care, remote patient monitoring (RPM), and more. Here’s a roundup of 8 newsworthy stories to share with physicians and staff in your medical practice.  

The specifics: The American Medical Association (AMA) recently released its 2025 CPT code update that takes effect January 1, 2024. The update includes 270 new codes, 112 deletions, and 38 revisions.

Why it matters: New CPT codes present new revenue opportunities that can help promote the financial sustainability of your medical practice.

What’s next: Review the changes to determine whether it makes sense to provide and bill for new services. For example, certain codes for remote therapeutic monitoring now include digital therapeutic intervention, device supply for data access, and data transmissions. There are also other important changes related to digital medicine, augmented/artificial intelligence, general surgery, and more.

The specifics: You’ve got until October 11, 2024 to ask the Centers for Medicare & Medicaid Services (CMS) for an informal review of your final 2023 Merit-Based Incentive Payment System (MIPS) performance-year scores if you believe there are errors in the calculations or the payment adjustment for the 2025 payment year. 

For example, you might have accidentally submitted data under the wrong taxpayer ID or National Provider Identifier. Or you might have a qualifying alternative payment models (APM) participant status, which means you shouldn’t receive a MIPS payment adjustment. Another scenario? You qualify for performance category reweighting because of extreme and uncontrollable circumstances, but the reweighting didn’t occur. You might also be able to submit a reweighting request if the Change Healthcare data breach affected your medical practice, rendering you unable to submit data by April 15, 2024. 

Note: CMS will not reweight performance category data if you’ve already submitted your data. 

Why it matters: This score directly affects your payments, and it’s important for CMS to get it right. Errors could cause you to leave significant money on the table.

What’s next: Log into the CMS Quality Payment Program portal to review your final MIPS score and make any changes as needed.

The specifics: Sixty-two percent of medical office staff say their time spent on billing compliance rose "somewhat" or "substantially" over the last 5 years, according to a recent survey. Sixty-eight percent of staff spend more time on prior authorizations as well.

Why it matters: As the billing-related administrative burden continues to grow, medical practices continue to struggle.

What’s next: Explore ways to automate RCM workflows and reduce unnecessary steps to increase efficiency, boost cashflow, and reduce claim denials.

The specifics: A recent study highlights what many of us already know: Physicians spend a lot of time working in their electronic health record (EHR). More specifically, they spend an average of 5.8 hours per 8 hours of time scheduled for patient care, though there is wide variation among specialties. The specialty with the highest amount of overall EHR time? Infectious disease specialists (i.e. 8.4 hours).

In a recent Tebra survey about patient interaction time, independent providers reported spending nearly half of patient time on EHR documentation. Providers reported spending 9 minutes per patient charting notes in their EHR, while appointment times with patients averaged 18 minutes.

Why it matters: This study highlights the considerable time spent on mandatory clerical work — time that competes with physicians’ ability to provide patients with their undivided attention. It’s also time that can exacerbate physician burnout and patient access challenges. 

What’s next: The AMA and others continue to advocate for reducing the EHR burden and helping you identify ways to increase efficiency and decrease busywork, and reduce physician burnout. AI may also be a solution. One recent study found that an AI-powered clinical documentation tool helped reduce time spent on EHR at home for almost 48% physicians, and nearly 45% reported less weekly time spent on EHR tasks outside of normal work hours.

The specifics: A recent KLAS survey found that interoperability is a major pain point for physicians. More specifically, physicians say interoperability is their top fix request, noting that external patient data often isn’t readily available in their EHR and, if found, is difficult to leverage.

Why it matters: Subpar interoperability adds to an already frustrating physician experience with many EHRs, and it may serve as a barrier to the continued adoption of health information technology. 

What’s next: The KLAS survey identifies several best practice solutions (e.g., commit to data sharing, coordinate with core sharing partners, focus on key health measures, and educate end users). Switching to a new EHR vendor with more robust interoperability may also be an option for your medical practice.  

The specifics: A recent study found that patients with a high school degree or less, and patients from minoritized racial and ethnic groups, experienced higher rates of claim denials, most frequently for preventive care. These patients also incur cost-sharing for these services that should be cost-sharing exempt. 

Why it matters: This administrative burden potentially perpetuates inequitable access to high-value health care.

What’s next: Pay attention to denials for preventive care. What is the root cause of each denial, and what can you do to address it proactively? 

The specifics: Researchers developed and tested a new screening tool to assess patients’ readiness for digital health. Their findings? A screening tool helps assess the complexity of factors influencing digital health uptake and highlights several areas for potential intervention. Read more about their findings here. 

Why it matters: As patients continue to face barriers to digital health, understanding each patient’s digital health readiness can help inform you on how to most efficiently and effectively deploy digital health readiness interventions across diverse populations.

What’s next: Think about the barriers your patients face in terms of accessing and using telemedicine, the patient portal, and other forms of health technology. What can your medical practice do to quantify these barriers and address them? While you’re at it, be sure to check out this new toolkit from the World Health Organization that addresses the growing challenges that persons with disabilities and other marginalized populations experience when accessing and using telehealth platforms around the world.

The specifics: A recent Office of Inspector General (OIG) report found that about 43% of Medicare enrollees who received remote patient monitoring (RPM) did not receive all 3 components of the service. 

Why it matters: OIG and CMS have raised concerns about fraud related to RPM, the use of which has increased dramatically from 2019 to 2022.

What’s next: Implement safeguards in your medical practice to ensure you use and bill RPM correctly. Be clear about the specific health data you monitor and audit these claims to ensure compliance.