Vital Signs: A January 2025 wrap-up of revenue cycle management healthcare news

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

January has been a busy month for revenue cycle management (RCM) news as physicians adjust to Medicare payment cuts, address potential patient collection challenges, and prepare for health policy changes with President Donald J. Trump’s inauguration. Here’s a roundup of 7 January 2025 RCM news stories to share with others in your medical practice or medical billing company. 

The specifics: With Trump’s inauguration comes many questions about healthcare policy reform and how it may affect healthcare providers. In particular, experts voice concerns about his plans to cut Medicaid spending and end Affordable Care Act (ACA) subsidies. 

Why it matters: According to a recent KFF report, about 44 million people (16.4% of the non-older-adult United States population) are covered by an ACA initiative. This includes 24 million people in ACA health plans and another 21.3 million in Medicaid expansion enrollment.

What’s next: It will be critical for providers to stay in the loop about important healthcare changes and their potential impact on the revenue cycle, including the potential for financial disruption. Tebra will continue to monitor developments.

The specifics: Congress recently agreed to extend telehealth waivers enacted during the COVID-19 public health emergency but only until March 25, 2025.

Why it matters: These waivers, which are critical for medical practices nationwide, allow Medicare patients to access telehealth services at any location in the country — and not just in rural areas.

What’s next: Stay tuned for additional guidance once the extension expires. 

The specifics: A new proposed rule seeks to strengthen cybersecurity protections for electronic protected health information (ePHI). Most notably, the rule proposes to remove the distinction between "required" and "addressable" specifications and making all of them mandatory, with limited exceptions.

Why it matters: This is the first the Health Insurance Portability and Accountability Act (HIPAA) Security Rule update since 2013. If finalized, it would aim to address significant changes in technology, breach trends, enforcement, best practices, and methodologies for protecting ePHI. It will be important to embrace these changes as research continues to show that cyberattacks against medical practices are on the rise.

What’s next: Familiarize yourself with key elements of the proposed rule, understand the potential impact on physicians, and stay tuned for a final rule.

The specifics: A new rule from the Consumer Financial Protection Bureau (CFPB) bans the inclusion of medical bills on credit reports and restricts lenders from obtaining or using medical information.

Why it matters: According to the new rule, the CFPB expects the ban will lead to the approval of approximately 22,000 additional, affordable mortgages every year and that Americans with medical debt on their credit reports may see their credit scores rise by an average of 20 points. However, for medical practices, this change may result in unintended consequences, including disincentives for patients to pay their bills.

What’s next: Discuss the potential impact of this new rule on your patient collections process. Perhaps now is the time to ramp up collection efforts and/or implement point-of-service collections.

The specifics: When comparing telehealth, patient portals, and mHealth applications, older adults (i.e., those between 50 and 80 years old) use patient portals most often, according to new research. 

Why it matters: It’s important to engage older patients in the medical practice’s overall patient portal strategy. However, researchers reiterate the importance of considering the unique characteristics of older adults when developing and deploying all types of digital health technologies to avoid worsening the digital divide.

What’s next: Examine your patient portal engagement levels among older adults. Consider whether any changes in terms of marketing the portal would increase adoption.

The specifics: A recent study found that physicians who address unmet health-related social needs (HRSN) (e.g., unmet needs related to housing instability, food insecurity, transportation barriers, and utility challenges) may experience higher rates of burnout compared with those who do not address HRSN and those who do so minimally. 

Why it matters: With the introduction of Healthcare Common Procedure Coding System (HCPCS) code G0136 (social determinants of health risk assessment) in January 2024, there is a plausible expectation that physicians’ engagement in addressing HRSNs will increase.

What’s next: To address HRSNs without further exacerbating existing burnout rates, physicians need support. Researchers say addressing HRSNs requires interdisciplinary teamwork (e.g., HRSN screening performed by nonphysician staff) and collaboration with interprofessional team members so physicians don’t feel helpless in being able to address patients’ needs.

The specifics: MedPAC members recently voted to replace the current fee-for-service update scheduled for 2026 with an increase equal to the increase in the Medicare Economic Index (MEI) — a measure of medical inflation — minus 1%. Since the MEI is expected to increase by 2.3% in 2026, that would give physicians a 1.3% pay bump.

The MedPAC recommendation also includes an extra pay increase for safety net providers who treat low-income Medicare beneficiaries. These providers would gain an average of an additional 1.7% to their pay, for a total increase of 3%. If Congress passed both parts of the recommendation, primary care clinicians would see an average 5.7% pay increase compared with 2.5% for all other clinicians. 

Why it matters: Many physicians continue to face financial hardships due to ongoing challenges related to payment cuts and decreasing reimbursement. If accepted, this recommendation would provide much-needed relief.

What’s next: The physician pay recommendation will be included in MedPAC’s March 2025 report to Congress. Stay tuned for additional developments.