Vital Signs: A June 2025 RCM healthcare news wrap-up

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 top insights and developments.

Summer has officially arrived, and with it comes rising temperatures, school vacations, and emerging developments related to Medicaid cuts, enhanced Medicare Advantage audits, health outcomes optimization, and more. Share the following news stories with physicians and staff members and discuss how you can prepare for upcoming changes and leverage best practices.

The specifics: The American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, American Osteopathic Association and American Psychiatric Association recently issued a statement urging lawmakers to protect patients’ access to affordable health insurance.

Why it matters: Proposed work reporting requirements, eligibility restrictions, and financial barriers could impact healthcare coverage for millions of people. Meanwhile, more doctors than ever before are moving to Canada to escape the Trump administration partially due to deep cuts to Medicaid.

What’s next: Stay tuned for additional developments, including the Senate vote on the budget reconciliation package sometime this summer. In the meantime, prepare your medical practice for potential Medicaid cuts using these strategies.

The specifics: The American Medical Association (AMA) says a recent analysis determined the budget neutrality-related cut in physicians’ 2024 Medicare payment rates was 3 times more than it should have been because CMS overestimated the use of code G2211 (add-on complexity code for evaluation and management (E/M) services delivered in outpatient and office visits settings). CMS projected physicians would bill G2211 with 38% of all outpatient and office E/M visits, but in reality, physicians only reported it with 10.5% of visits. 

Why it matters: The budget-neutrality adjustment in the 2024 final rule resulted in a 2.18% decline to the 2024 conversion factor, but the actual 2024 claims data suggest this should have been 0.79%, according to the AMA.

What’s next: Stay tuned for additional developments. The AMA wants CMS to correct the utilization estimate for G2211 based on actual claims data from 2024 by making a prospective budget neutrality adjustment to the 2026 conversion factor set to be published in the 2026 Medicare physician payment schedule proposed rule.

The specifics: A recent study found that implementing a 20-minute "portal practice slot" for physicians to address in-basket tasks during the workday improved physician well-being and decreased feelings of overwhelm. 

Why it matters: Researchers say these findings support the concept that system-level change recognizing in-basket work is possible and necessary to meaningfully address this issue that continues to plague physicians. A recent KLAS study found that 47% of ambulatory physicians report an excessive message volume, and the number of physicians reporting a high message burden is projected to grow as patients’ use of messaging tools expands.

What’s next: Look for ways to reduce the administrative burden associated with EHR inbox messages. For example, this recent study found that standardized protocols and clarifying roles and expectations for clinical team members responding to portal messages can go a long way in terms of reducing portal message burden and improving workflow.

The specifics: Eighty-five percent of physician groups say closing healthcare gaps positively impacts health outcomes, according to a recent report. Sixty-one percent say the same about the impact on financial performance. In addition, healthcare access, quality, and cost remain top priorities for physician groups. 

Why it matters: As the macro landscape shifts, challenges related to access, quality, and affordability remain central. However, nearly half of providers surveyed (i.e., health systems, hospitals, and physician groups) report they are not divesting from health outcomes optimization efforts in any capacity. Of the remainder, top areas to reduce investment include workforce inclusivity commitments, community and ecosystem partnerships, and philanthropic giving.

What’s next: Decide how your medical practice will continue to address healthcare disparities and close healthcare gaps. Doing so has many positive benefits for business and patient health.

The specifics: Nearly 7 in 10 Gen Z patients (68%) encountered at least one issue when paying for their most recent healthcare service, compared to fewer than 1 in 5 Baby Boomers, according to a recent report. The most common issues? Lack of digital payment options at the provider’s office, insurance coverage hassles, unexpected charges, and difficult-to-understand billing statements. 

Why it matters: Payment friction is a major source of frustration, especially for Gen Z and Millennial patients who increasingly prefer telehealth. About 30% of Gen Z and Millennials had their most recent healthcare visit remotely, compared to just 6% of Baby Boomers, the survey found.

What’s next: Re-evaluate the payment options you provide to patients to ensure a smooth patient financial experience that caters to all age groups.

The specifics: This recent article is a good reminder of the coding risks and pitfalls associated with audio-only telehealth, and it also provides documentation tips to promote compliance. 

Why it matters: Audio-only telehealth can present significant compliance risks. When billed inappropriately, it can lead to fraud or overpayment issues.

What’s next: Examine your telehealth documentation closely and educate providers on how to mitigate risk. In addition, be sure to stay abreast of any telehealth changes that occur after current telehealth flexibilities expire on September 30, 2025.

The specifics: On June 3, 2025, CMS submitted its FY 2026 budget request to Congress, and in it, the agency said it plans to increase its team of medical coders from 40 to approximately 2,000 by September 1, 2025. The goal? To address an ongoing backlog of Risk Adjustment Data Validation (RADV) audits to confirm that diagnoses used for payment are supported by medical records.

Why it matters: The last significant recovery of Medicare Advantage (MA) overpayments occurred following the audit of payment year 2007, despite federal estimates suggesting MA plans may overbill the government by approximately $17 billion annually. The Medicare Payment Advisory Commission estimates this figure could be as high as $43 billion per year. 

What’s next: While this news may be good for medical coders seeking employment, it’s also nerve-racking for providers, many of whom may face a significant rise in medical record requests. Experts say investing in clinical documentation improvement, coding accuracy, and provider education are critical. 

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