Articles of Interest in the World of Revenue Cycle Management from Advanced Data Systems RCM
UnitedHealthcare offers a group plan called Surest that features copays only, with no deductibles, coinsurance, or cost shifting. Health Care Service Corporation has introduced a similar model through its Simplified Health Care Coverage Option, signaling growing interest in this type of benefit design.
For clinical laboratories and anatomic pathology groups, these insurance structures could reduce patient A/R because responsibility balances tied to deductibles would not exist under those plans.
For more information, review the HCSC press release.
Regardless of your patients’ insurance coverage, ADSRCM helps practices capture responsibility balances as effectively as possible with tools such as patient responsibility estimation, out-of-network alerts, automated prior authorizations, repeated eligibility verification, and balance-due reminder texting.
Physicians entered 2025 facing another 2.83% reduction to Medicare Physician Fee Schedule reimbursements, marking the fifth consecutive year of Medicare payment cuts. At the same time, CMS estimated a 3.5% increase in the Medicare Economic Index, which reflects the rising cost of operating a medical practice.
The gap is significant. Reimbursements are decreasing while practice expenses continue to rise, which is why the American Medical Association and many other healthcare organizations have continued pressing Congress to address the issue.
For more context, review the AMA historical representation of revenues versus inflation and the American College of Radiology letter representing a broader healthcare coalition.
The Medicare Payment Advisory Commission recently recommended that Congress align physician reimbursements more closely with inflation in 2026 by tying payment rates to the Medicare Economic Index minus one percentage point.
That recommendation would represent a more durable improvement than one-time reimbursement adjustments because it would create a framework for future increases rather than a temporary patch.
Read the MedPAC report and the related AMA press release.
Whatever happens in 2026, the present challenge remains the same: reimbursements are down while operating costs are up. ADSRCM helps clients optimize reimbursement performance while easing staffing strain through outsourced support.
When patients or their authorized caregivers are blocked from accessing medical records, or when access is delayed, the 21st Century Cures Act can expose the responsible organization to penalties. That risk applies across healthcare settings, including physician practices, hospitals, and laboratories.
This is one reason ONC-certified EHR technology matters. A Cures Act-compliant EHR helps organizations support appropriate information access and reduce the risk of information blocking violations.
The enforcement risk is real. HHS recently imposed a $200,000 civil fine against a healthcare entity in Oregon for failing to provide timely access to medical records after repeated complaints and regulatory review.
Read the HHS press release for more detail.
Hospitals are required to make pricing information readily available to patients, prospective patients, and guarantors so they can better understand expected costs and plan financially. Health plans are also expected to provide pricing tools that show negotiated rates, out-of-network payment information, and prescription drug pricing data.
CMS can impose civil monetary penalties for noncompliance with hospital price transparency requirements. As noted on the source page, 18 penalties had been levied at the time of publication, with additional cases under review.
Review the PatientsRightsAdvocate.org article and the CMS list of penalized entities.
Transparency also matters operationally. ADSRCM gives clients on-demand visibility into data and reporting so they can see performance clearly and act on it quickly.
A North Carolina physician was sentenced to 30 months and ordered to pay more than $2 million in restitution after pleading guilty to healthcare fraud and money laundering.
According to the summary on the newsletter page, the physician owned a toxicology business and routinely ordered urine drug testing tied to opioid prescribing, then billed Medicare and North Carolina Medicaid for the highest possible reimbursements over a period of several years.
Read the IRS press release for the full case details.
Medicare telehealth flexibilities were extended for another six months through September 30, preventing the previously expected March 31 cutoff described on the source page.
That extension gave providers additional time to continue virtual care delivery for Medicare patients while longer-term policy questions remained unresolved.
For more, review the National Law Review article.
ADSRCM clients can access the ONC-certified MedicsCloud EHR and use the Medics Telemedicine app for virtual encounters, with ADSRCM also supporting related claims submission. Clients can also access remote patient monitoring tools that support reimbursable care management workflows.
April 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.
We strive to produce our monthly newsletters with news articles from the same month. Feedback or comments on our newsletters and content are greatly appreciated. Please opine by emailing marc.klar@adsc.com or by calling 800-899-4237, Ext. 2061. We’d love to hear from you.
Marc E. Klar
Vice President, Marketing, ADSRCM