Vital Signs: A May 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.

It has been a busy month of RCM news, including potential Medicaid cuts, evolving telehealth policies, upcoding across outpatient settings, ongoing physician burnout, prior authorizations, and more. Share these developments with your team to assess their potential impacts for your medical practice.

The specifics: A recent New England Journal of Medicine article highlights the “crushing weight” of nonclinical tasks on primary care physicians, who often function as de facto administrative assistants.

Why it matters: Authors warn that the US primary care system is at risk, and that specialists face many similar challenges.

What’s next:

Proposed solutions include: 

The specifics: Medicaid cuts could force providers to reduce services, lay off staff, or even close, experts say. This may particularly impact providers who serve low-income and rural communities.

Why it matters: Patient access could be compromised, with unknown long-term effects on outcomes and divisive health inequities. 

What’s next: Identify and pursue ways to become more efficient, promote revenue integrity, polish basic business skills, and reduce expenses. 

The specifics: Analysis shows a consistent trend toward higher-acuity billing in emergency departments, urgent care, and primary care offices. Between 2018 and 2023, CPT 99214 reporting grew from 38.5% to 45.0% in physician offices. In addition, all ICD-10-CM chapters saw an increase in high-acuity billing, with notable gains for mental health diagnoses in primary care.

Why it matters: While possibly partly due to real changes in patient acuity, this shift could indicate upcoding. Higher complexity codes translate to higher costs for patients and could also inflate system-wide spending.

What’s next: Assess if upcoding is an issue in your medical practice. Review documentation templates that encourage more detailed coding, revisit revenue cycle strategies for reimbursement optimization, and deepen your understanding of E/M billing guidelines. 

The specifics: Despite insurer and state efforts with gold card programs to streamline prior authorizations, experts say there’s room for improvement, calling for more transparency, data on their function, consistent application, and broader applicability across health plans.

Why it matters: Prior authorizations — including those for anti-obesity drugs — remain a major driver of physician burnout and can negatively impact patient outcomes and trust. 

What’s next: Experts suggest 3 fundamental changes to address prior authorizations: 

The specifics: While most Medicare telehealth coverage extends through September 30, 2025 — and COVID-era telehealth prescribing flexibilities last through December 30, 2025 — after these dates, anything is possible. Medical practices must prepare for various scenarios as telemedicine laws and regulations evolve.

Why it matters: Telehealth is crucial for patient access in many practices. Loss of current flexibilities could significantly impact revenue.

What’s next: Assess the potential impact of policy changes on reimbursement, licensure, and prescribing. Strengthen telehealth billing compliance to prevent fraud. Finally, consider if relocating your medical practice to a telemedicine-friendly billing state is a viable long-term strategy.

The specifics: A recent analysis found that 2 out of every 5 providers in physician practices are advanced practice providers (APP).

Why it matters: During provider shortages, effectively leveraging APPs can support operational continuity and financial sustainability.

What’s next: Evaluate how your practice could benefit from APPs, especially with ongoing staffing shortages. One recent study found that nearly half of physicians work with an incompletely staffed team more than 25% of the time. However, stay mindful of scope of practice expansions that could impact patient safety or physician-led care.

The specifics: Dentistry and podiatry most frequently contract with financial institutions to offer medical credit cards, according to a recent study.

Why it matters: As medical debt continues to rise, the impact of these cards on patients’ finances and health warrants active research, authors say.

What’s next: If you decide to offer a medical credit card, ensure patients fully understand the terms, especially regarding deferred interest after promotional periods. 

The specifics: A recent study shows steady improvements in access to care. Providers attribute this to telehealth, automation, digital tools, and flexible payment options. 71% of providers consider self-scheduling an urgent priority while 54% already offer it.

Why it matters: Timely access to care improves outcomes and helps contain costs.

What’s next: Evaluate patient access to your practice (scheduling, registration, check-in, communication, price transparency, payment ease). Automation, digital enablement, and AI can accelerate access, improve data accuracy, and mitigate staffing shortages.

The specifics: CMS issued a request for information from patients, caregivers, providers, payers, technology developers, and other stakeholders on digital health products for Medicare beneficiaries, data interoperability, and health technology infrastructure.

Why it matters: The agency aims to create a "patient-centric, digital healthcare system that is user friendly and provides real-world value for beneficiaries and their families."

What’s next: Submit comments by June 16 through the Regulations.gov website.

Are you interested in learning more about how digital health technology could improve your business? Whether you're a billing company who partners with private practices, or a practice owner wanting to run your practice more efficiently, Tebra can help.