Vital Signs: February 2024’s wrap-up of revenue cycle management healthcare news

Welcome to “Vital Signs,” your go-to monthly digest of all things related to RCM tailored specifically for independent practices. Want more? Look at previous editions and stay ahead with the latest insights and developments.  

February's revenue cycle management (RCM) landscape had an industry on high alert after a cyberattack on Change Healthcare — along with significant updates around the availability of procedure volume data on Medicare.gov and strategies to combat physician burnout through note bloat reduction. These developments highlight the importance of data transparency, efficiency in documentation, and proactive management of medical debt and telehealth services, aiming to improve patient care and compliance in the healthcare sector.

The specifics: On February 21, 2024, Change Healthcare (owned by United Health Group) suffered a cyberattack at the hands of a notorious ransomware group called BlackCat/ALPHV. In response, the company disconnected its systems from thousands of providers nationwide.

Why it matters: The disconnect caused significant problems with processing claims, billing patients, checking insurance coverage for care, filling prescriptions, and more.

What’s next: Stay tuned for industry developments regarding greater support for cybersecurity of physician practices. The Medical Group Management Association recently wrote a letter to HHS asking the agency to use all the tools at its disposal to mitigate the impact of this and future cybersecurity incidents. In addition, the American Medical Association provides these immediate steps: Communicate with payers regarding payment workarounds to bypass disrupted Change Healthcare applications, monitor the Change Healthcare incident update website, review HIPAA compliance programs, and more.

The specifics: The Medicare.gov compare tool now includes clinician- and physician-specific procedure volumes for these 12 procedures: Hip replacement, knee replacement, spinal fusion, cataract surgery, colonoscopy, hernia repair (groin, open), hernia repair (minimally invasive), mastectomy, coronary artery bypass graft, pacemaker insertion or repair, coronary angioplasty and stenting, and prostate resection. The data reflects procedures performed over the last 12 months for patients with Original Medicare and Medicare Advantage. 

Why it matters: Now that this information is publicly available, healthcare consumers may use it to make more informed decisions.

What’s next: Know your data. Visit the Medicare.gov website and review the compare tool to see where you stand compared to other providers. To view it, click on your individual profile page and select the “services” tab. You’ll see your annual number of procedures as well as how you compare with peers.

The specifics: The American Medical Association (AMA) is raising awareness of the detrimental effect of note bloat (i.e., using outdated templates and copy-paste functions in the EHR that result in irrelevant information in a clinical note) on physician efficiency. In this recent article, experts provides solutions to address this ongoing challenge.

Why it matters: In times of monumental physician burnout, addressing note bloat helps streamline efficiency. 

What’s next: AMA says it’s critical to recreate or update documentation templates to include only medically necessary information. For example, documentation that may have been necessary prior to 2021 (when new evaluation and management guidelines took effect) may now simply contribute to note bloat. Review your templates to see whether this is a problem in your medical practice.

The specifics: Recent data shows that medical debt is associated with financial vulnerability across a range of indicators. For example, adults with medical debt are more likely to be in a household that spends more than its income, find it very difficult to pay their bills, have no “rainy” day fund, or have had a big drop in income in the last year.

Why it matters: Medical debt is extremely common. More than 1 in 5 adults with health insurance have medical debt. Those with medical debt are much more likely to forgo medical care; skip tests, treatments, or follow-up care; or not fill a prescription. These inactions can impact outcomes and costs. 

What’s next: Identify ways to help patients afford the care they need whether it’s through payment plans or financial assistance. Financial counseling can help patients navigate the complexities of healthcare payments.  

The specifics: A recent OIG audit found that providers complied with Medicare requirements for 105 of the 110 sampled E/M services provided via telehealth during the first nine months of COVID-19. 

Why it matters: Favorable audit results may support continued telehealth expansion.

What’s next: Review this report and audit your telehealth services proactively to ensure compliance. Don’t assume compliance just because claims are paid. Post-payment audits are always a possibility. During proactive internal audits, be on the lookout for these important documentation elements: Time spent with the patient, new versus established patient, audio-only versus audio-visual telehealth (including the specific audio-visual product used), location of the provider or enrollee, physician signature, and more. 

Also be sure to reference the updated list of telehealth services for 2024 as well as 2024 telehealth policy changes prior to billing. 

The specifics: A new study found that patients were less likely to undergo a screening during a telehealth visit than an in-person visit early in the pandemic.

Why it matters: Depression is extremely common. As estimated 21 million adults in the United States had at least one major depressive episode in 2021. This number represents 8.3% of all U.S. adults. In addition, depression screenings help meet quality metrics and provide additional reimbursement. 

What’s next: Review telehealth workflows to ensure patients are screened for depression. Where are the gaps, and how can you improve consistency? 

The specifics: A recently-published Medlearn Matters (MLN) article (MLN9201074) outlines 4 new health equity-related services in the 2024 Physician Fee Schedule Final Rule: Caregiver training services, social determinants of health risk assessment, community health integration, and principal illness navigation.

Why it matters: We covered these services last month, but this new MLN article provides easy-to-reference guidance on how to document, code, and bill them correctly.

What’s next: Familiarize yourself with these services and decide whether it makes sense to provide them. Ongoing internal audits will be paramount.

The specifics: The April 1, 2024, ICD-10-CM update files are now available on the Centers for Disease Control and Prevention National Center for Health Statistics website. While there are no ICD-10-CM code changes, there are additions, deletions, and revisions throughout the various sections of the ICD-10-CM coding manual. 

Why it matters: These changes may impact the diagnosis codes you assign.

What’s next: Review the changes to ensure data and revenue integrity. Here’s a good recap from the American Academy of Professional Coders to help you understand the changes.

The specifics: New compliance risks are emerging for Ozempic, Wegovy, and similar drugs, and this article does a good job at providing tips to mitigate those risks.

Why it matters: A new report found that healthcare providers in the United States wrote more than 9 million prescriptions for diabetes and obesity medications in the last 3 months of 2022. These prescriptions increased by 300% between 2020 and 2022.  

What’s next: Take proactive steps to ensure compliance. This includes educating practitioners on these medications and insurance coverage requirements, implementing processes to review and respond to insurer requests for documentation, monitoring prescribing patterns, properly safeguarding medications to prevent theft, and more. 

The specifics: A New Jersey-based physician recently paid nearly $700,000 to resolve allegations he violated the False Claims Act by upcoding physician services, billing for more services than he could possibly provide in one day, and billing for services that he never provided. 

Why it matters: This is one of many cases that clearly indicate the government’s willingness to combat healthcare fraud. Be prepared to defend your billing, if necessary.

What’s next: Internal prospective audits are one of the most effective strategies to promote compliance. Focus on identifying potential cases of upcoding and provide physician education to mitigate risk. Also, focus on potential cases of “impossible days” (i.e., days on which a physician bills for a volume of services or procedures that they could not have reasonably performed — for example, billing 40 hours of E/M services on a specific date). 

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