April 2025 Newsletter Highlights
A Note From Natalie
Spring has Sprung!
Now is the time for new beginnings and fresh starts. We’d like to take a moment to thank our clients for their continued collaboration and dedication.
We also want to recognize a couple of notable dates this month, including World Health Day (April 7th) and HIP Week (April 21st - April 25th).
Looking for ways to spruce up your revenue cycle and improve coding compliance?
Remember: QualCode can help.
Natalie Williams ~ President & CEO
Revenue cycle leaders continue to invest in AI and advanced automation
The specifics: 92% of leaders indicate their top priority is to invest in AI and advanced automation for RCM, according to a recent study. Key focus areas for investment, in order of priority, include patient access, claim management, revenue integrity, patient financial care, denial prevention, and denial management.
What’s next: Start exploring the use of AI in RCM; however, be sure to take a mindful approach centered on change management and leveraging existing RCM staff and vendor partnerships in new ways.
CMS plans to end four innovative payment models by the end of 2025
The specifics: CMS recently announced the end of several innovative payment models by December 31, including Maryland Total Cost of Care, Primary Care First, ESRD Treatment Choices, and Making Care Primary.
What’s next: Participants should expect follow-up communication from their models with timelines, technical assistance, and other information regarding the wind-down and close-out. In addition, CMS will publish final evaluation reports from ending models to inform participants and other stakeholders of the important findings and insights about the tested approaches to value-based care.
Collection rate from commercially insured patients is on the decline
The specifics: The collection rate for providers from commercially insured patients fell more than 3 percentage points, from 37.6% in 2023 to 34.4% in 2024, according to a recent report. Experts say patient collections could become even more challenging as patients face higher deductibles and out-of-pocket expenses.
What’s next: Revenue cycle teams must refine financial counseling, improve point-of-service collections, and enhance patient payment strategies to mitigate the risk of delayed or lost revenue.