Articles of Interest in the World of Revenue Cycle Management from Advanced Data Systems RCM
In a “_ _ _ _ the torpedoes, full speed ahead” move (you can fill in the blanks), an AMA-sponsored bipartisan proposed bill would not only delete the 2.8% Medicare payment cut for 2025, but it would increase reimbursements by 2%.
Background is as follows: under the Medicare Physician Fee Schedule (MPFS), physicians operating under the MPFS started to get reduced reimbursements on January 1 by virtue of November’s CMS Final Rule. That same rule eliminated a temporary increase of 2.93%.
Several physician associations were vocal in criticizing the final rule's payment cuts, arguing that a 2.83% reduction in reimbursements makes it untenable for providers and practices, especially considering those entities have seen Medicare rate reductions for several consecutive years, exacerbated by growing practice expenses and continuing workforce shortages.
Enter the hero in the form of the Medicare Patient Access and Practice Stabilization Act. If passed, the bill would not only roll back the cuts but also provide a 2% increase. The MGMA is also backing the proposal, with the AMA noting that physician reimbursements have fallen 33% since 2001.
For more information, review the AMA reference here and the press release here.
Importantly, ADSRCM clients’ claims are already submitted for maximum reimbursement, helping practices derive as much revenue as possible with the cuts currently in place. If the legislation passes, those gains would become even more meaningful.
According to a HIPAA Journal report, 84% of healthcare organizations detected a cyberattack in 2024. Not suspected. Detected. Most incidents involved hijacking or phishing.
An important takeaway is that both cloud-based and on-premises systems experienced issues. Neither deployment method was immune.
Given the prevalence of cyberattacks in healthcare, protecting your organization as thoroughly as possible is critical. Practices should also ensure that any vendors they work with digitally maintain strong protections of their own.
Read the full HIPAA Journal report here.
ADSRCM systems are protected by multiple layers of security, and servers are hosted by Equinix, a global leader in cloud-based hosting and security.
An AI-driven EHR is relied on for clinical charting and reporting, but its value extends far beyond documentation. It also supports functions such as e-prescribing, telemedicine, remote patient monitoring, clinical decision support, and interoperability as required by the 21st Century Cures Act.
Today, the AI capabilities of an EHR can automatically and ambiently capture relevant conversations between patients and providers, then insert that content correctly into the patient record while allowing providers to remain hands-free. This is changing how encounters are completed.
These functions create an EHR that works for the provider rather than the other way around. Ultimately, that operational efficiency also benefits patients, even when they do not see all the moving parts behind the scenes.
Just as important, an effective AI-driven EHR should instantly prepare the claim with the required elements in place, including support for complex E/M coding, HCC coding for optimized reimbursement, and NCCI editing so claims are bundled appropriately when needed to avoid denials.
In other words, the EHR should be “thinking” about the clinical and financial integrity of every encounter.
To complete the circle, an ONC-certified EHR also helps organizations stay compliant with the 21st Century Cures Act by supporting interoperability and helping providers avoid information blocking risks.
In short, practices should ensure their EHR is doing its part to keep operations fluid, efficient, compliant, and financially sound.
ADSRCM clients can access the ONC-certified MedicsCloud EHR, which supports these workflows across dozens of specialties. Organizations that prefer to retain their current EHR can also keep those systems interfaced with ADSRCM.
According to a University of Michigan study, people aged 14 to 24 prefer to self-test for STIs. The leading reasons were increased privacy and reduced stigma.
As for prostate cancer, a Journal of Urology report based on surveys by Vanderbilt University and the University of Michigan found that an at-home urine test proved as accurate as samples collected onsite at a healthcare facility. The approach may help reduce the need for MRIs and biopsies.
Read the University of Michigan press release on STI self-testing and the Vanderbilt report on prostate cancer self-testing.
Effective since January 1, 2022, the No Surprises Act was created to protect patients against unexpected medical bills whenever possible. The law is especially important in emergency scenarios, where patients often have little control over which providers or services are involved.
Out-of-network situations are especially common in emergencies involving services such as ambulance transport, anesthesia, radiology, surgeons, or emergency physicians. Even when a facility is in-network, the individual providers involved in treatment may not be.
In these situations, claims are typically submitted to the patient’s insurer. The payer determines reimbursement, and the patient may then receive a balance-due statement. That is often what creates a surprise bill.
There can also be cost sharing through copayments or coinsurance, which patients may not have anticipated in advance.
Here are several core guidelines under the No Surprises Act:
This is only a basic refresher. For a more detailed breakdown, visit CMS guidance on the No Surprises Act, including information on how patients can report potential violations.
The broader goal is straightforward: avoid surprise billing and align reimbursement with the approved payment framework.
ADSRCM clients using MedicsPremier can receive out-of-network alerts in advance, helping staff identify in-network provider options for the patient and planned services. The MedicsPremier Patient Responsibility Estimator can also provide close approximations of what a patient may owe before services are performed, helping reduce billing surprises and keep patient A/R under tighter control.
March brings more items of interest in the world of revenue cycle management.
Contact ADSRCM at 844-599-6881 or rcminfo@adsc.com to learn more about driving stronger revenue and productivity with ADSRCM. Clients can access the ONC-certified MedicsCloud EHR and its built-in MedicsScribeAI for natural language data capture during encounters. Organizations can also retain their current EHR if preferred. The MedicsCloud Suite is also available from ADS for teams that prefer in-house automation.
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Marc E. Klar
Vice President, Marketing, ADSRCM