A recent report says hospitals are seeing financial relief as operating margins stabilize, but leaders are being warned to proceed with caution.
The latest data from Kaufman Hall shows hospitals are seeing some financial relief as revenue increases offset rising expenses and operating margins stabilize, the August 2023 report says.
The median year-to-date operating margin index increased from 0.9 percent in July to 1.1 percent in August, according to the data. While these margins are still below historical levels, it's noteworthy that hospitals have consistently achieved positive margins since March.
Another win coming from the Kaufman Hall report is in revenue growth. Hospitals experienced robust revenue growth, outpacing expense increases, the report said. Net operating revenue increased by 8 percent month-over-month, while gross operating revenue rose by 9 percent.
Inpatient (4 percent) and outpatient revenue (12 percent) also posted significant gains from July to August. Hospital CFOs should continue to focus on revenue optimization strategies, particularly in the outpatient setting, where care transitions have been evident.
While margins seem to be trending in a positive direction and are starting to show a gradual recovery from the financial challenges brought on by the pandemic, CFOs are being told to remain cautious.
Ben Finder, director of policy research and analysis at the American Hospital Association, recently took aim at the “false narrative from hospital critics” that tell leaders they are in the financial clear.
“Hospital critics frequently focus exclusively on a fleeting period of stability, ignoring other available data that show the real costs of cascading waves of illnesses, inflationary pressures, and skyrocketing expenses for drugs, labor, supplies and equipment,” Finder said in his recent AHA blog post.
Taking a look at the big picture shows a much different story, Finder says.
Fitch, Moody’s, and S&P all released reports describing how nearly every metric of hospital and health system financial health declined in 2022, Finder said.
“Operating margins and earnings deteriorated significantly, days cash on hand (a measure of financial resilience) declined, and as a result, most agencies are reporting significantly more credit rating downgrades than upgrades,” Finder said.
CFOs know they need to be looking at big-picture results when examining financial health, and it’s evident that while finances have been improving, hospitals and health systems won’t be out of the woods any time soon.
The Kaufman Hall report paints a cautiously optimistic picture for hospital CFOs. Positive operating margins, efficient expense management, and revenue growth indicate a continued recovery from pandemic-related challenges, but as patients resume more typical care patterns and days of cash on hand remain low, CFOs must remain vigilant in managing costs and optimizing revenue while adapting to the evolving healthcare landscape.
Hospitals and health systems aren't the only entities facing financial pressures from rising labor costs.
The recent announcement of American Physician Partners (APP) filing for bankruptcy has significant implications for hospital CFOs who are actively working to reduce their reliance on contract labor.
The APP's decision to wind down its business affairs reflects the challenges that healthcare staffing companies can face in a dynamic market. In fact, the APP cited financial challenges that are similar—if not the same—to what healthcare organizations have been facing for years: financial pressures from the COVID-19 pandemic, rising labor costs, and No Surprises Act burdens.
At the time, Envision Healthcare said various challenges including declining patient volumes, reduced reimbursement, the No Surprises Act, and rising inflation played into its bankruptcy filing. Envision has since undergone a restructure.
Aside from being a large expense, relying heavily on staffing firms can expose hospitals to financial vulnerabilities in the event of unforeseen circumstances, such as bankruptcy. Hospital CFOs may need to reassess their vendor relationships, diversify their staffing sources, and consider new strategies for recruiting and retaining home grown staff.
In fact, this is exactly what Scott Wester, president and CEO of Memorial Healthcare System, a South Florida-based nonprofit system, prioritized for his organization.
“COVID changed the landscape of how we dealt with the workforce, predominantly the reliance on agency nurse travelers, outside contractors, and not having enough personnel to meet the demand that was out there, mostly on the clinical side,” Wester said.
“We spent almost $280 million a year utilizing outside contract or incentive pay and heavy reliance on nurse travelers. We recognized we needed to get people back to wearing our Memorial badge. Over the course of 12 months, we've dropped about 80% of use of outside contract labor. We're now about a $200 million savings just on that perspective,” Wester said.
So how did Memorial pull it off? The organization did it by bolstering its talent acquisition team, making sure to play more offense than defense, and by reaching out to the work community to try to figure out what was limiting people from joining the organization.
As for future trends, CEOs and CFOs are likely to continue exploring alternative staffing models, not only for financial reasons, but for risk-management as well. As we know, the COVID-19 pandemic accelerated the adoption of telehealth, and this trend is expected to persist as hospitals seek innovative ways to optimize their workforce and reduce costs.
Additionally, CFOs may increasingly invest in workforce management tools and data analytics to make more informed decisions about staffing needs, ultimately enhancing operational efficiency and financial stability in the face of these industry challenges—which probably won’t be going anywhere anytime soon.
CFOs at healthcare organizations of all sizes are feeling the heat when it comes to offering competitive salaries to attract and retain top talent—but leaders of small- and medium-sized hospitals are really feeling the squeeze.
This was a major theme at HealthLeaders’ inaugural Teams Exchange which brought clinical and financial c-suite leaders together in Nashville to talk shop.
The concern for the workforce is not new—in fact leaders have been strategizing for years on how to retain and attract talent, even before the pandemic. What is newer though, is the fact that hospital margins are continuing to deteriorate while the need for in-house staff is skyrocketing.
Labor expenses were a top concern for most of the CFOs at the event, so pulling back on agency use is a top priority, especially since the money CFOs pumped into contract labor during the pandemic is now majorly stressing the bottom line. But this means organizations need to recruit and retain talent in house and on a budget.
Gone are the days when CFOs of smaller organizations can throw money at the problem—i.e., salary increases and bonuses—to attract and keep talent, especially when a hospital 20 minutes down the road can pay their nursing staff 700% more for the same job (a true story shared by a CNO at the event).
So, what can leaders do to bolster the workforce while keeping expenses low? Placing an emphasis on culture and scheduling flexibility is a great place to start, the attendees agreed.
Here are several budget-friendly strategies that emerged from the event that both clinical and financial leaders can employ to bolster their workforce:
Asses your employee benefits and perks: Offer a comprehensive benefits package that includes health insurance, retirement plans, and additional perks such as flexible work schedules, wellness programs, or tuition reimbursement.
One CFO at the event said employee benefits is one of the largest expenses for their organization, but balancing offerings that are both cost effective and robust will make your hospital more attractive to potential employees and improve overall job satisfaction.
Prioritize training and staff development: Provide budget-neutral ongoing training and professional development programs. Staff value opportunities to enhance their skills and advance their careers, so offering educational support, workshops, or mentorship programs can demonstrate your commitment to their growth. Cross-training employees in various roles within the organization is also a great way to enhance schedule flexibility and help bridge staffing gaps.
Form recognition or reward programs: Implement a robust recognition and rewards program to acknowledge and celebrate employee achievements. Non-monetary rewards, like public recognition, awards, or personalized thank-you notes, can boost morale and motivation.
Emphasize work-life balance: Promote work-life balance by offering flexible scheduling, remote work options (where feasible), and paid time off. Emphasizing the importance of a healthy work-life balance can help attract and retain staff. Some attendees even entice their nursing staff with a few days of remote work via virtual nursing technology.
Implementing wellness initiatives to support employee health and reduce burnout can also help in this area too. These programs can include stress reduction workshops, access to fitness facilities, and mental health support.
Create career advancement opportunities: Create a clear career path within the organization. Staff are more likely to stay when they see opportunities for advancement. Encourage internal promotions and provide training for leadership roles.
Streamline existing technology: Be creative in ways to bolster the technology and tools you already have to streamline workflows and reduce administrative burdens. This can improve staff efficiency and allow them to focus more on patient care.
Prioritize community involvement: The attendees agreed that many healthcare professionals—especially those in more rural areas—are motivated by a sense of purpose and making a difference in the community, so highlight your hospital's role within the community and engage employees in community service or outreach programs.
Incorporating a combination of these strategies can help small and medium-sized hospitals strengthen their workforce, improve staff satisfaction, and remain competitive in the healthcare industry without solely relying on salary increases.
HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community on LinkedIn.
To inquire about attending a HealthLeaders Exchange, email us at exchange@healthleadersmedia.com.
The fiscal year 2024 ICD-10-CM codes are now effective, and they will impact your reimbursement.
Earlier this year, CMS announced the addition of 395 new diagnosis codes, 25 deletions to the diagnosis code set, and 13 revisions—all of these updates were implemented October 1.
An ample amount of the code changes pertain to reporting certain diseases, accidents and injuries, and social determinants of health (SDOH).
This 2024 diagnosis code update comes at a time when hospitals and health systems are working more diligently than ever to address their patients’ social needs and the broader SDOH in the communities they serve.
When it comes to updates to SDOH, there are 30 new diagnosis codes for factors influencing health status and contact with health services. There are also a host of new guidelines for reporting these codes.
For example, there is a new code for reporting an encounter for HIV pre-exposure prophylaxis. A “code also” note instructs coders to report risk factors for HIV, when applicable.
An extensive “code also” update for “other specified problems related to upbringing” says codes for the following diagnoses should also be reported when applicable:
Absence of a family member
Disappearance and death of family member
Disruption of family by separation and divorce
Other specified problems related to primary support group
Other stressful life events affecting family and household
Robust data related to patients’ social needs is critical to hospitals’ efforts to improve the health of their patients and communities. One way to capture data on the social needs of patient populations is through proper documentation and keeping revenue cycle staff up to date on code changes, which will help to better identify non-medical factors that may influence a patient’s health status.
The other new diagnosis codes are spread throughout the code set, with several dozen pertaining to osteoporosis with fractures, retinopathy and muscle entrapment in the eye, and disease of the nervous system—including Parkinson’s disease and epilepsy.
Of the 395 new codes, 123 of them reside in the external causes of morbidity chapter of the ICD-10-CM manual, specifically new codes to capture accidents and injuries.
From prior authorizations to coding, regulatory news ranked high in popularity for revenue cycle leaders this summer.
This summer was a busy one for revenue cycle leaders as new regulations dropped, lawsuits were filed, and providers continued to fight prior authorization provisions.
Take a look at the stories that mattered most to our revenue cycle leaders this summer.
CMS recently announced the addition of 395 new diagnosis codes, 25 deletions to the diagnosis code set, and 13 revisions. An ample amount of these changes pertains to reporting certain diseases, accidents and injuries, and social determinants of health (SDOH). As mentioned, these code updates will take effect on October 1.
The new diagnosis codes are spread throughout the code set, with several dozen pertaining to osteoporosis with fractures, retinopathy and muscle entrapment in the eye, and disease of the nervous system—including Parkinson’s disease and epilepsy.
The American Hospital Association, the American Medical Association, the Blue Cross Blue Shield Association, and AHIP came together to urge CMS to not proceed with implementing proposed prior authorization standards that the organizations stated would be costly and conflicting.
In a letter penned to the federal agency, the groups argued that the provisions of the December 2022 Notice of Proposed Rule Making would be detrimental "due to conflicting regulatory proposals that would set the stage for multiple PA electronic standards and workflows and create the very same costly burdens that administrative simplification seeks to alleviate."
Cigna is on the wrong end of a class action lawsuit that alleges the payer improperly denied members' claims through an algorithm.
The lawsuit was filed in the Eastern District of California by two Cigna members who claim they were both denied payment due to Cigna's PXDX algorithm—one plaintiff was rejected for an ultrasound and the other was denied for a vitamin D test.
According to the lawsuit, PXDX allows doctors to automatically reject payments "in batches of hundreds or thousands at a time," enabling Cigna to bypass the legally-required individual physician review process.
CMS says it collects quality data from hospitals paid under the IPPS with the goal of driving quality improvement through measurement and transparency to help consumers make more informed decisions, however gathering this information for CMS is proving time consuming and expensive for hospitals.
The study published in JAMA set out to evaluate externally reported inpatient quality metrics for adult patients and estimate the cost of data collection and reporting, independent of quality-improvement efforts, and the conclusion was staggering.
A new report underscores the significant financial burden that denials pose for organizations.
Revenue cycle leaders need to address denials management and embrace tech solutions, and they should have done so a long time ago as the financial implications of denials is huge.
According to a recent study, with more than 40% of surveyed providers losing over half a million dollars annually due to claim denials, and 18% losing more than a million dollars, the financial impact is substantial, the 2023 Plutus Health Revenue Cycle Management Challenges Index says.
For these reasons and more, 43 percent of respondents to the survey said denials management is among their top priorities this year.
Denials management wasn’t alone however, as healthcare organizations said other revenue cycle priorities this year include specific payer challenges, staffing, patient eligibility and benefits verification, prior authorization, claim submission, and patient collections.
The key insight here is that revenue cycle leaders must recognize the urgency of integrating and streamlining technology to bolster their processes. By doing so, revenue cycle leaders can enhance efficiency in filing claims, reduce errors, accelerate cash flow, gain access to valuable business analytics, and ultimately provide better patient care.
Here are a few other key takeaways from the report:
Claim denials are a costing organizations big time.
The report highlights that claim denials are still a top financial burden for healthcare providers. As mentioned, more than 40% of respondents reported annual revenue losses exceeding half a million dollars due to denied insurance claims, with 18% losing over a million dollars annually.
Embracing technology is a must, but it’s not always happening.
While technology has demonstrated its effectiveness in improving revenue cycle management processes, the survey indicates that many healthcare providers remain hesitant to adopt AI and RPA. The report emphasizes the urgent need for the organizations to embrace these technologies and says that those who have integrated AI and RPA report benefits such as improved efficiency, reduced errors, faster cash flow, and better access to business analytics, highlighting the tangible advantages of adopting these solutions.
Payers and staffing are still ranking high on the revenue cycle leader’s list of challenges.
Coming in closely behind denials management, 44% of respondents cited “specific payer challenges” as a top concern, and 41% said managing staffing needs is still a major issue. This suggests that healthcare providers should not only invest in technology but also address workforce shortages and consider a combination of internal and external support to optimize their payer relations.
From coding to case management, revenue cycle tech projects are full speed ahead all throughout the revenue cycle spectrum.
Technology implementation is not new to revenue cycle, and leaders need to think outside of the traditional revenue cycle box when it comes to new technology.
Revenue cycle isn’t just patient access and billing, it spans across the clinical space too. Saving big in revenue cycle doesn’t just mean shoring up your patient-facing processes, revenue cycle leaders need to be looking in the clinical space too.
Here are three organizations who are placing a focus on middle revenue cycle technology.
The organization:
Henry Ford Health
The goal:
To improve efficiency in its coding workflows, resulting in lower costs, reduced backlogs, and enhance patient and provider experiences.
The background:
Henry Ford Health expanded its collaboration with CodaMetrix to include patient bedside visits, where abstraction takes an average of 40 minutes per patient and accounts for 20% of the health system's overall coding costs.
AI improves Henry Ford’s bedside medical coding process in several ways. First, it automatically codes the simplest procedures, taking that work off its coders’ plates. By 'simplest,' they mean the procedure notes that match closely or exactly with how the ICD codes themselves are written.
The technology does this by bringing together all the complex information required to identify, understand, and code a bedside professional charge. It then predicts and assigns charges and diagnosis codes, automating cases directly to billing.
The platform also creates a nuanced understanding of the patient journey and can identify potential charge gaps where services were likely provided but there is no documentation. Once identified and routed to coders for follow up with providers, these estimated charge gaps can equal as much as 8% of overall bedside revenue that was previously left unbilled.
By implementing the AI, Henry Ford predicts it will increase workflow efficiency by reducing errors, missed charges, billing backlogs, and claim denials while lowering costs.
The organization:
Hillcrest HealthCare System
The goal:
To create a new care model through technology that encompassed five ‘rights:’ The right patient, care, setting, documentation, and billing/payment. Using this approach, patients would be placed at the center of the conversation, with communication and care facilitated by a resource manager following that person throughout their encounter and beyond.
The background:
Hillcrest HealthCare System, the Oklahoma market of Ardent Health Services, needed to move away from siloed utilization review, care coordination, and discharge planning functions that sat side-by-side.
Hillcrest is very large in scale, so to set up a model where patients come first and processes are designed to serve them best, it needed the right technology.
Historically, it’s been a challenge for Hillcrest to introduce technology that would enable this process at the level needed. The labor required was always too great, the quantity of data needed was too vast, and consistency and leadership at scale was hard to achieve.
However, in mid-2020, it implemented XSOLIS’ CORTEX® platform to address those challenges and allow clinical staff to refocus their efforts on the patient, not administrative work. With it, the staff has access to a real-time, artificial intelligence-driven view of each patient’s medical necessity, prioritizing cases by revenue sensitivity and risk while also using the platform as a channel to communicate with payers.
In the first two years, Hillcrest’s inpatient-only alerts caught $1.76 million in potential missed inpatient revenue. Along with a 12% reduction in observation rates, this has resulted in an additional $3.28 million in inpatient revenue.
The healthcare system was also able to improve observation-to-inpatient conversion rates from 27% to 52% while reducing inpatient-to-observation downgrade rates to about 4%, a 50% sustained reduction. Inpatient denials were reduced by 102.34% in the first year.
The organization:
University of Iowa Hospitals and Clinics
The goal:
To use a “data-driven surgery” program to examine how surgical procedures are conducted, how devices and supplies are used, and where surgical team members are placed. Administrators could then look for more efficient workflow adjustments that might save time or reduce wasteful processes or the use of supplies.
The background:
University of Iowa Hospitals and Clinics (UIH) launched its data-driven surgery program in July 2021 in a partnership with Caresyntax, one of several digital health companies developing technology platforms to improve operational and clinical efficiency in different parts of the hospital. The hardware and software program taps into connected devices and platforms throughout the OR while capturing audio and video recordings of the procedure.
Using that data, UIH administrators can gain a better understanding of how surgical procedures are done, as well as how the different members of the surgical team work individually and as a team.
By leveraging EHR data review teams can also take into account clinical outcomes.
The health system has used this technology to make some short-term improvements in OR procedures, mainly affecting efficiency and room turnover rates. UIH says having 5-10 minutes off of a procedure can be an enormous amount of time saved when played out over 50 or more OR rooms.
UIH sees other areas of the hospital where this technology could help, such as the emergency department. The technology could also play a part in credentialling and training programs, especially as healthcare organizations move into value-based care and gain a better understanding of how clinical services affect the revenue cycle.
The recent UAW strike draws on similar workforce concerns revenue cycle leaders have been facing with their staff for years: technology advancement.
While the recent United Auto Workers’ (UAW) strike is historic for many reasons, the union’s asks aren’t a far cry from the demands of the healthcare workforce.
One demand by the UAW, though, parallels an issue revenue cycle leaders have been facing with their workforce for years: wanting to know where they stand in the wake of technology advancement.
For context, the UAW is voicing its concern—along with better employment benefits and wage increases—over job security related to an increase in electric-powered vehicles that require fewer parts and fewer laborers. They want to make sure their jobs remain secure as technology advances. Who else is thinking the same? Your revenue cycle staff.
We know that healthcare organizations are embracing revenue cycle automation and AI at a fast pace, with executives seeing technology as a means of improving the quality and accuracy of tasks, reducing manual labor, and improving clinical and staff workflows.
In fact, automation in the revenue cycle isn’t an if, it’s a when, and each time you implement new technology in the department, it’s not improbable that your revenue cycle staff is questioning their viability.
While the concerns of your revenue cycle staff might differ slightly from the situation faced by the UAW, at a time when workforce retention is top of mind and nearly half of healthcare workers fear that AI could take their jobs, hospital leaders need to pay attention to these massive industry strikes.
Luckily, there are a few valuable lessons that hospital leaders can draw from in this labor dispute to protect their teams from the fears of job insecurity as automation and AI continues to take hold of the revenue cycle.
Create open and transparent communication
Leaders need to maintain open lines of communication with revenue cycle staff and address concerns about technology and AI encroaching in on their department. Be transparent about the organization's plans and reassure staff that technology is meant to complement their work, not replace it.
Invest in staff training
Demonstrate your commitment to employee growth by investing in continuous training and upskilling. Show that the organization values its employees' development and is willing to adapt to changing technology together.
In fact, advancing employees’ skills should be viewed through the lens of your business objectives. As upskilling and reskilling are increasingly part of the workplace conversation, business leaders need to approach these programs as far more than short-term soultions for staff.
Emphasize job security
Make it clear that while technology may change job roles, it doesn't necessarily mean a loss of jobs. Emphasize the importance of human judgment, empathy, and critical thinking the revenue cycle—skills that are not easily replaceable by AI.
On the front and back end, patients value the human touch in these interactions, and this will continue to be a critical aspect of the revenue cycle.
And as for critical thinking, coders or clinical documentation improvement staff often use these skills to query providers and report more accurately—something AI can’t do.
Make it known AI is a tool, not a replacement
Revenue cycle leaders implement AI and technology to enhance the efficiency and accuracy of revenue cycle processes, not to necessarily replace FTEs—so make sure your staff knows that is the intention. Showcase how these technologies can reduce administrative burdens, allowing them to focus on more strategic and patient-centered tasks.
Employ collective problem-solving
Engage staff in discussions about how technology can improve their workflow and address pain points. Encourage them to provide input and be part of the decision-making process when adopting new technologies.
Provide fair compensation and benefits
While there’s a fine line between competitive salaries and financial stability, leaders should ensure that revenue cycle staff receive competitive compensation and benefits. Address any disparities or concerns related to wages and benefits promptly.
Share the long-term vision
Share the organization's long-term vision for revenue cycle technology and how staff will be integral to achieving it. Make it clear that their roles will evolve and adapt alongside technology. Leaders also need to remember that revenue cycle technology is only as good as the human staff that runs it behind the scenes.
That all being said, incorporating these strategies can help revenue cycle leaders proactively address concerns among their staff. Leaders need to ensure a more stable and collaborative work environment, which will reduce the likelihood of future workforce issues due to automation and AI advancements.
In the largest price transparency fine yet, University of Florida Health North was docked $979,000 by CMS.
UF Health North received a $979,000 price transparency fine due to several compliance violations under the No Surprises Act—a big reminder that revenue cycle leaders need to be prioritizing compliance.
According to CMS, UF Health North failed to uphold several requirements under the price transparency requirement:
Failure to update standard charge information annually: Hospitals are required to update the standard charge information annually. UF Health North failed to do so, leading to noncompliance.
Incomplete data elements in the list of standard charges: Hospitals must include all corresponding data elements in the list of standard charges, including descriptions for each item and service, payer-specific negotiated rates, and de-identified minimum negotiated charges. UF Health North did not fully adhere to these requirements, CMS says.
As the number of fined organizations is sure to grow, revenue cycle leaders need to make sure to streamline price transparency strategies.
Here are a few tasks that revenue cycle leaders need to make sure are prioritized:
Regularly update pricing information: Revenue cycle leaders should establish processes to ensure that standard charge information is updated by revenue cycle teams at least once annually, as mandated by CMS. This involves keeping track of changes in charges for services and items.
Comprehensive data inclusion: This is an area UF Health received the most dings, so leaders need to meticulous in making sure all relevant data elements in your list of standard charges is present. This includes descriptions, payer-specific negotiated rates, and deidentified minimum negotiated charges.
Implement or streamline shoppable services display: Organizations need to have a user-friendly online display of shoppable services, making it easy for patients to access and understand pricing information for common procedures.
Conduct regular compliance audits: Hospitals should conduct routine self-audits to assess their compliance with price transparency regulations. Really, audits should be in place for all compliance regulations. Also, make sure to identify and rectify any deficiencies promptly.
Educate staff: Your entire revenue cycle staff—from front end to backend—should be well-informed about the importance of price transparency compliance and trained to provide patients with accurate cost information.
Engage legal and compliance experts: The revenue cycle isn’t siloed. Continually seek the advice of the legal and compliance experts in your organization (or even outside your organization if necessary).
Stay informed: Revenue cycle leaders should be staying up-to-date with evolving regulations related to price transparency. Regulations in general are everchanging, so staying abreast of even the most mundane regulations can save you big in the long run.
Respond promptly to CMS notices: If your organization receives a notice of noncompliance from CMS, it is crucial to respond promptly and take corrective actions as required.
As denial prevention and accurate reimbursement weigh heavy on revenue cycle leaders, staying up to date on code updates minimizes these challenges greatly.
Having teams report incorrect or outdated codes can result in claim denials, delays in reimbursement, and revenue disruptions.
While coding seems like merely a middle revenue cycle task, accurate reporting also impacts financial reporting and analysis as it affects resource allocation, budgeting, and strategic planning. In this sense, incorrect reporting could potentially skew financial reports and hinder effective decision-making.
This makes knowledge of coding changes essential for everyone from the biller to the revenue cycle leader.
The most recent coding update comes from the American Medical Association (AMA) as it recently released the 2024 CPT® code set, which includes hundreds of new codes and a push for more inclusivity for certain patients.
Here are five key takeaways from the AMA’s 2024 CPT code update that revenue cycle leaders need to know.
The AMA is taking steps to improve accessibility for Spanish-speaking patients: The AMA is incorporating Spanish language descriptors for over 11,000 medical procedures and services in the 2024 CPT code set.
There are over 300 updates to the code set: The 2024 update includes 230 additions, 49 deletions, and 70 revisions.
COVID-19 immunization reporting has been streamlined: The AMA consolidated more than 50 codes related to COVID-19 immunization reporting. The consolidation of these codes and the introduction of provisional codes for specific vaccine products demonstrate are a push toward more accurate and streamlined reporting for the virus.
RSV immunization codes have been added: For organizations treating patients of all age groups, but especially children and the elderly, there are new CPT codes for reporting product-specific RSV immunizations. Accurate coding for these immunizations can aid in data-driven planning and allocation of resources as these immunizations are fairly new.
Clarifications in E/M services reporting were made: Revenue cycle leaders should be aware of the revisions made to the reporting of evaluation and management (E/M) services. These revisions aim to provide clarity and consistency in coding, including changes related to office visits, split/shared E/M visits, and hospital inpatient services.
As previously reported, there are also hundreds of changes to the diagnosis code set being implemented October 1.
