Vital Signs: An April 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.

It has been a busy month for revenue cycle news, and we’ve rounded up several of the most important stories this month on topics related to Medicare Advantage payments, physician burnout, GLP-1 medication coverage, and more.

Share these stories with physicians and staff members and discuss how emerging developments may affect your medical practice.

The specifics: Centers for Medicare & Medicaid Services (CMS) recently finalized an increase in the average benchmark payments to MA plans by 5.06%, or $25 billion — a change that will benefit large United States health insurers.

Why it matters: The payment boost comes at a time of increasing scrutiny over Medicare Advantage payments, and government spending generally. 

What’s next: With these increased payments to MA payers comes the potential for better negotiated rates with providers, bonuses, and higher quality-based incentive payments. However, MA plans may simultaneously expect more from providers in terms of clinical documentation, quality scores, and patient satisfaction. Stay tuned for additional developments.

The specifics: Experts say global tariffs announced on April 2 could impact medical practices and other healthcare businesses and that costs may rise on protective equipment, supplies, medical devices, and more.

Why it matters: Medical practices may feel acute pressure when vital supplies become more expensive and harder to secure. 

What’s next: Craft a comprehensive plan to ensure operational continuity. Communicate with suppliers and staff, diversify the supply chain, contain costs, protect cash flow, and plan for future disruptions. 

The specifics: This recent article acknowledges the importance of weighing various factors before implementing telemedicine in a medical practice. These factors include national and local policy, size and specialty of the medical practice, medical practice culture, and infrastructure. 

Why it matters: Using a framework for telehealth implementation can help medical practices be successful as regulations and reimbursement models continue to evolve.

What’s next: Explore ways in which your medical practice can make better-informed decisions about whether, when, and how to expand telemedicine services. However, keep in mind that by the end of 2026, some predict that around 30% of all medical appointments in the US will be conducted via telemedicine technologies.

The specifics: In a letter dated April 11, 2025, the American Medical Association (AMA) asked Optum to use an individualized, practice-by-practice approach for recouping Change Healthcare cyberattack-related loans and not ask for loan repayment until the physician determines that their business is back to normal.

Why it matters: The AMA says physician practices continue to suffer severe financial distress as a result of the cyberattack nearly 14 months after the breach was first discovered.

What’s next: Stay tuned for additional developments as well as media reports on healthcare providers receiving threatening letters demanding repayment in full or risking reimbursement for claims being withheld.

The specifics: A recent study found that although burnout among US physicians improved between 2021 and 2023, occupational distress in physicians remains markedly elevated relative to the US workforce. 

Why it matters: Authors of the study cite these potential negative consequences of physician burnout: poor quality of care, decreased patient satisfaction, increased physician exodus out of the profession, and more.

What’s next: Explore ways in which technology can mitigate physician burnout and reduce administrative burden. Sometimes, simple steps can have a profound impact on physician well-being. For example, this recent report cites emerging evidence suggesting a positive impact of ambient scribes on physician burnout.

The specifics: Implementing collaborative care management (CoCM) in primary care improves clinical outcomes for mild-to-moderate depression and anxiety and non-acute suicidal ideation, according to a recent study. It also enhances health equity and lowers total healthcare costs.

Why it matters: There is now strong, real-world evidence that the broadscale implementation of CoCM in primary care would drive a national reduction of suicide risk. It can also help boost medical practice revenue.

What’s next: Consider whether it makes sense to provide collaborative care management to patients. Physicians can generate additional revenue because Medicare, most commercial insurers, and more than 30 state Medicaid programs reimburse primary care providers for delivering this service. To learn more, be sure to check out this CMS guide.

The specifics: In this recent article, the AMA warns physicians not to lose oversight and control of their private practice’s billing processes. 

Why it matters: Medical coding and billing forms the foundation of a successful medical practice. Third-party billers can either promote financial sustainability or leave a medical practice vulnerable to denials, audits, and recoupments. 

What’s next: The AMA advises ensuring that there’s a comprehensive contract in place that protects the interests of physicians and their medical practices. It’s also important to establish a transparent service level agreement, key performance indicators for accounts receivable, and plans for how both parties would respond to a data breach.

The specifics: CMS recently published its April 2025 quarterly update to the physician fee schedule.

Why it matters: The update includes various new, revised, and deleted HCPCS codes of which medical practices should be aware.

What’s next: Review the changes and be sure medical coding and billing teams are up to date on what’s new.

The specifics: A recent study found that indirect billing in Medicare is common, underrepresenting the role of APCs while exaggerating the work of physicians. More specifically, indirect billing by APCs occurred for 39% of all office-based encounters with Medicare patients in 2022.

Why it matters: Identifying indirectly billed visits helps quantify the role of APCs in caring for Medicare patients. As APCs represent a growing share of the clinical workforce, identifying APC-provided care that is billed indirectly is integral to understanding who serves Medicare beneficiaries. 

Understanding how often indirect versus direct billing occurs among APCs could also save Medicare money. In 2022, Medicare fee-for-service spending on office-based services delivered during indirectly billed APC-provided encounters was $1.8 billion. If providers billed this care directly, Medicare could have saved approximately $270 million.

What’s next: Stay tuned for additional developments about how the role of APCs continues to evolve over time. Also brainstorm compliant ways to leverage APCs more effectively in your own medical practice.

The specifics: The percentage of US adults who can’t afford or access quality healthcare has reached 11% (i.e., nearly 29 million people) — its highest level since 2021, according to a recent survey. The survey categorizes these individuals as "cost desperate" as opposed to "cost secure" and "cost insecure."

Why it matters: The rising percentage of cost desperate Americans reflects the financial strain and real-life anxiety that many individuals continue to experience. And with the inability to pay for healthcare services comes delayed care, poorer outcomes, and higher overall costs.

What’s next: Ensure patients understand their financial obligations and consider offering payment plans and patient financing programs. Create a clear financial strategy for your medical practice.

The specifics: With expanding FDA indications for GLP-1 medications, and recent manufacturer announcements introducing more affordable cash-pay options, primary care physicians must stay up-to-date on patient coverage to guide patients properly, says one physician. 

Why it matters: GLP-1 medication policies and coverage change frequently.

What’s next: Appoint someone in your practice to stay abreast of changes and educate physicians as patient interest in these medications continues to increase.