Vital Signs: An October 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.

October has been a busy month in revenue cycle management with headlines addressing a variety of topics important to today’s medical practices, including temporary telehealth provisions, electronic funds transfer (EFT) fees, the gender payment gap in healthcare, and much more. Here’s a roundup of 8 newsworthy stories to share with physicians and staff in your medical practice.  

The specifics: Several temporary telehealth provisions will expire after December 31, 2024, including the waiver of in-person visit requirement for behavioral health, coverage of audio-only services, expansion of covered telehealth services, waiver of geographic and originating site requirements, and more.

Why it matters: If these provisions expire, there could be significant implications for Medicare patients, more than 1 in 10 (12.7%) of whom received a telehealth service in the final quarter of 2023.

What’s next: Stay tuned to find out whether Congress votes to extend telehealth flexibilities beyond December 31. Here are the latest updates.

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The specifics: UnitedHealthcare recently launched its gold card program designed to modernize the prior authorization process and simplify the healthcare experience for consumers and healthcare professionals. 

Why it matters: Prior authorizations continue to create a significant administrative burden for many medical practices, and this program could provide some relief.

What’s next: Learn more about the program and determine whether you qualify. Also note that this program only applies to certain procedures.

The specifics: This recent American Medical Association (AMA) article reminds us that physician engagement is critical in denial prevention and overall effective revenue cycle management. 

Why it matters: When practices empower physicians to understand revenue cycle management, this can decrease the long-term workload and improve the medical practice’s overall productivity and profitability.

What’s next: The AMA urges readers to leverage tools in their electronic health record and design a physician education plan that includes information about evaluation and management codes, commonly used procedure and drug codes, bundled procedures or medications, common modifiers, prior authorizations, and payer policies. 

The specifics: In this recent op-ed, one physician voices support for the No Fees for EFTs Act that would bar vendors from charging physicians unnecessary fees for EFT payment transactions.

Why it matters: Nearly 60% of physicians say they are forced to pay these fees without ever having agreed to them. Two-thirds of physicians say more than 75% of their annual revenue is paid via EFT payments, and larger practices can pay up to $100,000 in EFT fees annually.

What’s next: Stay tuned for future developments. And be sure to check out various AMA electronic payment resources. 

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The specifics: According to the 2024 Female Physician Compensation Report, there remains a significant difference in pay for male versus female physicians with men, on average, earning 29% more than women in calendar year 2023 (the survey period).

Why it matters: This difference in pay tends to perpetuate women not feeling valued and respected which ties into job satisfaction and burnout.

What’s next: There’s a growing awareness of this pay gap with some calling for more accurate and transparent salary data to close the payment gap.

The specifics: A new issue brief from the AMA explains the role of Current Procedural Terminology (CPT) in value-based care (VBC) arrangements today, including where it is supportive and where there may be opportunities for continued evolution. The information in the issue brief is based on interviews with more than 40 individuals across 34 organizations representing VBC provider organizations, health plans, integrated delivery systems, VBC enablement organizations, health technology organizations and others. 

Why it matters: This issue brief represents AMA’s commitment to ensuring the CPT code set evolves to support the delivery of high-quality patient care. 

What’s next: Stakeholders interviewed for the issue briefly shared potential ideas for the future, including evolving CPT codes to reflect new types of practitioners delivering healthcare services, supporting new care delivery models with bundled service codes, and considering how CPT might address new types of healthcare services. 

The specifics: Blue Cross Blue Shield has agreed to pay $2.8 billion to resolve antitrust class action claims by hospital systems, physicians, and other healthcare providers. The lawsuit, initially filed in 2012, alleges providers were underpaid and that the nationwide conspiracy increased the cost of insurance and drove down reimbursements. The agreement is subject to approval from United States District Judge R. David Proctor.

Why it matters: This lawsuit will undoubtedly affect many providers. More specifically, it covers US healthcare service providers, including hospitals and some doctors, with Blue plan patients between July 2008 and October 2024.

What’s next: The Court is expected to review the Motion for Preliminary Approval in November, and a formal notice will be sent to all class members at a later date determined by the Court.

The specifics: The Office for Civil Rights (OCR) recently announced it would impose a $240,000 HIPAA fine on Providence Medical Institute after a series of ransomware attacks affected the electronic protected health information (ePHI) of 85,000 patients. OCR found that the provider did not have a business associate (BA) agreement in place and failed to implement policies and procedures to allow only authorized individuals or software programs access to ePHI.

Why it matters: Ransomware attacks are on the rise. In fact, there has been a 264% increase in large breaches reported to OCR involving ransomware attacks since 2018.

What’s next: OCR recommends ensuring BA agreements are in place, conducting risk analyses, implementing audit controls, using multi-factor authentication, reviewing information system activity regularly, encrypting ePHI, providing education and training, and incorporating lessons learned from incidents into the overall security management process.