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Vital Signs: A wrap-up of revenue cycle management news for December 2023

This December 2023 RCM wrap-up includes compliance updates, preparations for new codes, and fee schedule changes.

Medical practice manager reads about revenue cycle management news

At a Glance

  • Legislation has been introduced to eliminate planned Medicare physician payment cuts in 2024.
  • Medical practices continue facing financial pressures with expenses rising much faster than revenues, highlighting the need for careful cost control and revenue cycle management.
  • While physicians see potential benefits of artificial intelligence to reduce burdens, concerns remain about impacts on privacy, relationships, and oversight needing continued attention.

Welcome to Vital Signs: a monthly roundup of RCM news for independent practices.

Like always, it has been a busy month for healthcare revenue cycle management (RCM). Medical practices are preparing for new CPT codes and updates to the Medicare physician fee schedule that take effect on January 1, 2024. Here are 7 RCM stories to put on your radar as you turn the page into a new year.  

1. Legislation introduced to eliminate Medicare physician payment cuts

The specifics: US Rep. Greg F. Murphy, MD, R-N.C., has introduced legislation (Preserving Seniors' Access to Physicians Act of 2023 [H.R. 6683]) that would eliminate a 3.4% planned cut to Medicare physician payments starting in January 2024. 

Why it matters: If passed, this legislation could be a game changer. Why? Physician payment cuts could cause negative secondary and tertiary implications. The payment cut also threatens the viability of physicians in rural areas. 

What’s next: Keep your eyes and ears open for further developments. H.R. 6683 is currently in the first stage of the legislative process.

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2. New MLN Matters® article summarizes the calendar year 2024 Medicare Physician Fee Schedule Final Rule 

The specifics: A new MLN Matters article provides a summary of coding and billing changes important to today’s medical practices. A related article that provides more in-depth information (including examples of how to report the new complexity evaluation and management [E/M] add-on code) can be found here

Make sure your billing staff know about coding and billing changes taking effect January 1, 2024. ”

Why it matters: These important changes impact payment starting January 1, 2024. 

What’s next: Make sure your billing staff know about changes to telehealth services, E/M visits, behavioral health services, dental and oral health services, therapy services, diabetes self-management training services, community health integration services, principal illness navigation services, social determinants of health assessments, and caregiver training.

3. Medical group expenses continue to outpace revenue

The specifics: Median total revenue per physician has risen 9.1%, and median total expenses per physician grew 26.5% between 2020 and 2023, according to a new survey from the American Medical Group Association.

Why it matters: These results highlight the increasingly difficult task of ensuring medical practice financial sustainability in today’s high-cost healthcare environment. 

What’s next: Medical practices must control expenses very carefully while simultaneously ensuring proper revenue cycle management and compliance. What is your plan for 2024 and beyond?

4. AMA helps medical practices provide, bill for behavioral health integration 

The specifics: The American Medical Association (AMA) recently published an article with links to several resources for medical practices that want to provide behavioral health integration (BHI).

Why it matters: BHI can be tricky to initiate and sustain. It requires buy-in from diverse practice resources, including information technology, billing, primary care physicians, and behavioral health professionals.

What’s next: Review the article and download the resources that include a BHI compendium and behavioral health coding resource. Figure out whether it makes sense to provide this type of integrated care in your own medical practice.

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5. Physicians identify EHR progress, areas for improvement in recent Medscape report

The specifics: In terms of progress, 72% of physicians say it’s getting easier to use EHRs, according to a recent Medscape report. In addition, 43% say it’s easier to respond to patient issues. 

However, 52% say the amount of face-to-face time with patients has worsened with EHRs. Additionally, 56% say they are ‘very’ or ‘somewhat’ concerned about mistakes in the EHR that may harm patients. The top 3 reasons why physicians may switch EHRs are to exchange information with other EHRs, merge inpatient and outpatient EHRs, or improve clinical documentation processes. 

Take a close look at your own EHR and evaluate whether it meets your medical practice needs. ”

Why it matters: This mixed feedback indicates there is room for improvement.

What’s next: Take a close look at your own EHR and evaluate whether it meets your medical practice needs. Will it continue to meet your needs going forward? If not, it may be time to reconsider your options.

6. OCR settles its first-ever phishing cyberattack investigation

The specifics: A Louisiana-based medical group recently settled with the Office for Civil Rights (OCR) after a phishing attack affected the electronic protected health information of approximately 34,862 individuals. The medical group agreed to pay $480,000 to OCR. It also agreed to implement a corrective action plan that OCR will monitor for 2 years. 

Why it matters: Phishing is the most common way that hackers gain access to health information. These attacks can result in identity theft, financial loss, discrimination, stigma, mental anguish, and more.

What’s next: Learn from this medical group’s mistakes. Implement security measures to reduce risk and vulnerability and develop and maintain written policies and procedures to comply with HIPAA, Additionally, provide training to all staff who have access to patients’ protected health information.

7. Physicians voice excitement (and concern) about the use of artificial intelligence (AI) in healthcare

The specifics: Physicians are generally excited about using AI to reduce administrative burdens in healthcare, according to a recent survey conducted by the AMA. The survey showed that 54% of physicians want to use it to improve clinical documentation, and 48% say it can help with prior authorizations. However, 41% are concerned about patient privacy, and 39% are concerned about the impact on the patient-physician relationship.

Why it matters:  There has been considerable movement at the federal level over the last year to embrace AI in healthcare. In October 2023, President Biden issued an executive order on safe, secure, and trustworthy AI requiring the federal government’s health agencies to devise a strategy for overseeing AI with provisions related to the healthcare sector. 

In addition, in April 2023, the Office of the National Coordinator for Health Information Technology published a proposed regulation on transparency related to predictive decision support interventions (DSI) incorporated into certified electronic health records, including DSI, which uses generative AI. A final rule was published on December 13

What’s next: Evaluate your medical practice’s current use of AI and start talking about potential strategies to expand in an ethical and compliant way for generation of chart summaries, creation of care plans and patient-facing health recommendations, analysis of patient-generated health data, and more.

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Lisa Eramo, freelance healthcare writer

Lisa A. Eramo, BA, MA is a freelance writer specializing in health information management, medical coding, and regulatory topics. She began her healthcare career as a referral specialist for a well-known cancer center. Lisa went on to work for several years at a healthcare publishing company. She regularly contributes to healthcare publications, websites, and blogs, including the AHIMA Journal. Her focus areas are medical coding, and ICD-10 in particular, clinical documentation improvement, and healthcare quality/efficiency.

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