Vital Signs: An April 2024 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. You can access previous editions for the top insights and developments here.

There’s lots of revenue cycle management (RCM) news to report this month — with topics ranging from new codes to billing for e-visits, to generative artificial intelligence (AI) at the point of care and ongoing recovery from the Change Healthcare cyberattack. Here’s a roundup of newsworthy RCM stories.

The specifics: Medicare pays for message-based e-visits; however, fewer than 1% of Medicare beneficiaries were billed for them, one recent study found. Primary care physicians bill for e-visits more frequently than other specialties, according to the study.  

Why it matters: These findings alleviate concerns regarding the potential overuse of portal message and e-visit billing. 

What’s next: Determine whether it makes sense to bill for e-visits for low-complexity medical issues. These visits could be an untapped revenue source for your medical practice; however, you’ll need to approach the topic carefully and with a willingness to address patient concerns about charging for messages.

The specifics: Significant problems continue for providers — particularly small medical practices with 10 or fewer physicians — in the wake of the Change Healthcare cyberattack, according to a recent survey from the American Medical Association (AMA). More than 77% of survey respondents have experienced service disruptions since February 21 and are still feeling the effects of the cyberattack.

Why it matters: Ongoing financial strain and an inability to process claims may cause some medical practices to close their doors entirely, AMA President Jesse M. Ehrenfeld, MD, MPH said in a press release about the survey results. 

What’s next: Stay abreast of advocacy work, congressional activity, and other updates and resources here. 

The specifics: Effective April 1, 62 new HCPCS Level II codes took effect as part of CMS’ quarterly update.

Why it matters: The updates also include discontinued codes and revised descriptors. Understanding and implementing these changes helps prevent claim denials.

What’s next: Familiarize yourself with the changes. Here's an article from the American Academy of Professional Coders that can help. Also be sure to view your Medicare Administrative Contractor’s website for more information as well. Here’s a link to one of them.

The specifics: Forty percent of US physicians say they would use generative AI when interacting with patients at the point of care, according to a recent study. However, 89% want content source transparency — meaning they want vendors to be open about where information comes from, who creates it, and how it is sourced. 

Why it matters: There’s an upward trend of physician acceptance of generative AI. Sixty-eight percent of physicians say they’ve changed their minds about generative AI in the past year and are now more likely to think it would be beneficial to healthcare. On the other hand, patients remain concerned when doctors use generative AI to diagnose and treat.

What’s next: Think about ways in which generative AI could benefit your medical practice such as improved care team interactions with patients, the ability to quickly search medical literature, the ability to summarize patient data in the electronic health record, and more. Also think about questions you’ll ask generative AI vendors to ensure applications are useful and trustworthy.

The specifics: The AMA, National Association of Accountable Care Organizations, and America’s Health Insurance Plans recently collaborated to publish a playbook of voluntary best practices for value-based care (VBC) payment arrangements. The goal of the 74-page guide? Help support a sustainable future for VBC. 

Why it matters: Many barriers to physician participation in VBC payment arrangements still exist, namely the complexity and unpredictability of reimbursement. The playbook explains the importance of transparency in VBC payment arrangements, flexible features, clear communication, and shared expectations. It also highlights the need to engage health plans, physicians, practices, and VBC entities in co-designing these arrangements.

What’s next: Use this playbook to explore new VBC payment arrangements and/or improve existing ones. 

The specifics: Despite a 3% increase in total compensation, the majority of US physicians (61%) say they’re underpaid, according to a recent survey. Twenty percent say they take on other medical-related work to boost their income.

Why it matters: Lack of adequate compensation can be a source of physician burnout, causing some providers to leave the medical field entirely during a time when physician shortages — particularly in primary care — are already a serious concern.

What’s next: Stay abreast of AMA advocacy work to reform Medicare payment. In the meantime (and when appropriate), leverage billing codes for transitional care, chronic care management, advance care planning, and complex patient evaluation and management services to generate additional revenue and support financial sustainability.

The specifics: The proposed agenda for the May 2024 CPT Editorial Panel meeting includes several new codes for remote patient monitoring (RPM), including:

Why it matters: If approved, some experts say these new RPM codes could enable providers to expand their existing RPM programs and earn additional revenue.

What’s next: Experts continue to tout RPM as a way to address ongoing patient needs while reducing the number of in-person office visits. They say it also helps steer patients in the right direction in terms of when and where to receive care, thus helping to reduce the number of unnecessary hospital and in-office visits. Stay tuned for more RPM updates, including changes that may ultimately help providers launch and grow their own RPM programs while simultaneously preventing overutilization and other forms of fraud and abuse. 

The specifics: Accountable Care Organizations (ACO) led by independent practices and include a relatively large number of primary care physicians save more money for Medicare than hospital-led ACOs. That’s according to a recent report from the nonpartisan Congressional Budget Office.

Why it matters: This report underscores the important role that primary care physicians play in cost containment. That’s because these providers can manage patients’ chronic conditions and provide preventive screenings, thereby reducing the need for higher-cost specialty care or treatment settings such as emergency departments.

What’s next: Stay tuned for potential policy changes that could lead to greater ACO savings especially through the Medicare Shared Savings Program, such as increasing providers’ share of ACO-generated savings, restructuring or extending incentive payments, or temporarily limiting downside risk.