At a Glance
- Staffing shortages persist in healthcare, with high turnover rates reported for front office, clinical support, and business operations staff.
- Updates to CPT, HCPCS, and ICD-10 codes took effect October 1, 2023. Practices must review the changes to ensure accurate coding and avoid denied or delayed payments from payers.
- Proposals are underway to remove medical debt from credit reports to aid Americans financially after medical crises. However, this could negatively impact practices’ patient collections.
- Practices should ramp up engagement, education, and transparency around patient financial responsibility.
Welcome to Vital Signs: a monthly roundup of RCM news for independent practices.
September 2023 was a busy month for revenue cycle management (RCM) news. It’s that time of year when independent medical practices and medical billing companies turn their attention toward new, revised, and deleted ICD-10-CM codes. Claim volumes increase as patients seek healthcare services before annual deductible resets. RCM managers start to take stock of what worked well during the year and the compliance vulnerabilities they want to address looking ahead.
As always, RCM news — and lots of it — happens daily in the background. But don’t worry, we’ve got you covered. Here are some stories that should be on your radar this month.
1. Healthcare staffing shortages persist
The specifics: In 2022, front office staff experienced a turnover rate of 40% across all practices, with clinical support and business operations support staff turnover rates closely behind at 33%, according to a new report published by the Medical Group Management Association (MGMA).
A recent Tebra survey echoes these data results, indicating 1 in 3 healthcare workers plan to leave their job within the next year, and 14% plan to leave the industry entirely.
“A recent Tebra survey echoes these results, indicating 1 in 3 healthcare workers plan to leave their job within the next year, and 14% plan to leave the industry entirely. ”
Why it matters: Many believe a healthcare crisis will occur within the next year due to understaffing and employee burnout.
What’s next: Medical practices and billing companies must strive to recruit and retain staff through fair salaries and comprehensive benefits packages. They must also leverage practice automation, when possible, to offset staffing gaps and improve productivity and efficiency.
2. AMA released its 2024 CPT code changes
The specifics: The American Medical Association (AMA) released the 2024 CPT code updates that includes 230 code additions, 49, code deletions, and 70 code revisions. These changes, which take effect January 1, 2024, include consolidated codes for COVID-19 immunizations, removed time ranges from office or other outpatient visit codes (99202-99205, 99212-99215), and more.
Why it matters: With CPT code changes come opportunities for streamlined efficiency and increased reimbursement.
What’s next: Medical practices and billing companies should review these changes and ensure coders and physicians are aware of any new requirements.
3. Proposals are underway to remove medical debt from credit reports
The specifics: In September, the Consumer Financial Protection Bureau (CFPB) announced it is beginning a rulemaking process to remove unpaid medical bills from American credit reports.
The goal? To help families financially recover from medical crises, stop debt collectors from coercing people into paying bills they may not even owe, and ensure that creditors don’t rely on inaccurate data.
Why it matters: Roughly 20% of Americans report having medical debt, according to a 2022 report. However, research shows that medical billing data on a credit report is less predictive of future repayment than reporting on traditional credit obligations.
What’s next: Although this news may be good for many Americans, it may not be as advantageous for medical practices during a time of high-deductible health plans when patients are directly responsible for more of their healthcare bills than ever before.
Medical practices should start conversations now about how to ramp up patient collections through billing automation, ongoing patient engagement, education, and price transparency.
4. Varied digital health coverage hinders progress
The specifics: A recent AMA analysis uncovered a lack of coverage alignment for digital health services (i.e., remote physiologic monitoring, remote therapeutic monitoring, asynchronous interprofessional consults, and asynchronous online evaluation and management communication) across commercial insurers, Medicare, and Medicaid.
Why it matters: Fully embracing digital health would mean commercial health plans could create more equitable payment methods and design robust value-based payment programs. Digital tools could also simplify administrative requirements, promote technological development, enhance better communication among specialists, and more.
What’s next: The AMA advocates for expanded coverage of digital medicine codes and increased transparency around coverage and payment as well as continued evidence-based best practices for digitally enabled care.
5. MIPS penalties could be significant in 2024
The specifics: 2022 data will affect payment adjustments under the Merit-based incentive payment system (MIPS) starting January 1, 2024 — and the AMA says physicians may be in for an unpleasant surprise.
Why it matters: Penalties can cut Medicare payment by as much as 9%.
What’s next: Review performance feedback. If there are any errors, consider submitting an appeal, also called a targeted review. But act quickly. The deadline to submit a targeted review is October 9, 2023.
6. HCPCS Level II code update takes effect October 1
The specifics: In this 113-page document, CMS explains various HCPCS Level II coding updates that took effect October 1. The changes include an additional 47 codes for billing Medicare for services/supplies, 2 discontinued codes, revised long descriptors of 4 existing codes, and 2 revised codes.
“As with any coding update, if you don’t stay on top of the changes, you’ll likely experience denied or delayed payments. ”
Why it matters: As with any coding update, if you don’t stay on top of the changes, you’ll likely experience denied or delayed payments.
What’s next: Review this most recent quarterly update and ensure everyone in your organization is aware of the changes.
7. New, revised, and deleted ICD-10-CM codes took effect October 1
The specifics: Most of the 78 new ICD-10-PCS codes for 2024 (40 codes to be exact) represent new procedures, substances, and devices. The ICD-10-CM update includes 395 new ICD-10-CM codes, many of which promote clinical specificity.
Why it matters: If you didn’t implement these changes in your medical practice or billing company as of October 1, payers may deny or delay payment.
What’s next: Review the coding changes as well as the 2024 ICD-10-PCS official coding guidelines and the 2024 ICD-10-CM official coding guidelines.
While you’re at it, take a look at the proposed addenda revisions indicated and discussed at the September 12 to 13, 2023 ICD-10 Coordination and Maintenance Committee Meeting being considered for implementation on April 1, 2024.
November 15, 2023, is the deadline for receipt of public comments on proposed new codes and revisions discussed at the September 12 to 13, 2023 ICD-10 Coordination and Maintenance Committee Meeting and being considered for implementation on October 1, 2024.
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