The agenda looks to be timely and compelling. Here are some of this year’s topics:

• Summary of the Federal Fiscal Year (FFY) 2025 Centers for Medicare & Medicaid Services’ (CMS) Final Rulings and Hot Reimbursement Topics
• 2024 Legislative Update: Implications for Healthcare RCM Leaders
• Declining Self-Pay Recovery Rates — Want to know why?
• Strategies to unlocking potential and improving productivity
• Medicare Enrollment Updates, Challenges, and Potential Penalties for Non Compliance
• Understanding Observation Services in 2024
• A Well-Oiled Machine: Departments Working Together for Better Reimbursement
• Protecting Revenue with Automation Technology for Medicaid and Charity Care Enrollment
• The New Data Privacy Laws, Update on Privacy Class Action Litigation, and Mitigating Privacy Risk Through Insurance
• Navigating the Nexus: Understanding A.I. Opportunities and Cybersecurity Threats in Healthcare
• Charting the Course: Building a Sustainable Health Care Workforce for the State of New Jersey
• Never underestimate the power of a denial!
• Coding Compliance and Risk Mitigation: Protecting Your Revenue
• Managed Care Benchmarking in the Era of Price Transparency
• Powering Value-Based Contract Success—Strategies to Empower Providers and Drive Operational Excellence
• Fight Payer Denials with Final Rule CMS-4201-F
• Is this the End of Agency Deference? The New Landscape of Administrative Law and the Impact on Healthcare Providers.
• Lessons learned from a successful AI Implementation of Computer Assisted Coding
• Monetizing Clean Energy Capital Improvements
• Automating Data Governance to Support Effective Analytics
• From Denial to Recovery: Upgrading Your Approach to DRG Downgrades
• Navigating Compliance: Lessons from Recent Enforcement Activity
• Utilizing Educational Relationships to Address Workforce Challenges

We look forward to seeing you there!

Sheri Hovan

President & CEO

Coding & Billing Solutions

1. Many of Epic’s announcements were focused on how the software company is integrating artificial intelligence into its products. Epic Systems CEO Judy Faulkner said that Epic has more than 100 AI features in the works, though many of the tools are still in the early stages of development.
2. Faulkner said that by the end of 2025 its generative AI will help doctors convert message responses, letters and instructions into plain language that patients can easily understand.
3. Doctors will be able to use AI to automatically queue up orders for prescriptions and labs, the company said.
4. In order to help physicians streamline time-consuming tasks such as reviewing prior authorization requirements and drafting insurance denial appeal letters, Epic said it is working to introduce AI tools that can streamline those processes this year.
5. Epic announced that by the end of 2025, its generative AI will be able to pull in the results, medications and other details that a doctor might need when responding to a patient’s message through MyChart. Other specific functions, like using artificial intelligence to calculate wound measurements from images, will also be arriving by 2025.
6. Epic announced plans for a new staff scheduling application for physicians and nurses called “Teamwork” that’s coming soon.
7. Judy Faulkner also explained that Epic is “investigating” how it could facilitate claims submissions directly through its software, without the need for a middleman like a clearinghouse. If Epic is successful, it could mark a major change in the way that insurance claims are processed throughout the health-care industry.

These announced changes are very significant, and it is yet to be seen as to whether they will operate as promised and the extent to which the industry will adopt these changes.

Whether these features will all come to fruition — and whether health systems will actually use them — isn’t yet known. Even so, Epic ended its presentation Tuesday by showcasing a demo about where the company believes its technology can go.

The Future of Epic Systems

In a demo about the future of its systems, Seth Hain, senior vice president of research and development at Epic, was the facilitator. Seth spoke to an artificial intelligence agent through the MyChart app about his recovery after a hypothetical wrist surgery and answered questions about his pain. The AI agent instructed Hain to open his camera and bend his wrist back so it could evaluate the progress of his healing. The agent said Hain’s wrist extension was about 60 to 75 degrees, which meant his recovery was ahead of schedule, compared to data from similar patients in Epic’s Cosmos database.

Hain then asked the agent if he could start playing pickleball again, and it told him that he “should still wait a little longer” before doing so.

In a meeting with reporters after the presentation, Hain said the demo was happening in real-time without human intervention. However, that capability is so new that Epic doesn’t even have a name for it yet, and Hain said it will likely be a few years before it’s more widely available.

″It is very, very, very early in regards to how and where the community, the broader medical community, will adopt that type of thing, but it’s viable,” he said.

At CBS, we will be monitoring Epic’s developments in AI very carefully and advising our clients on how to best manage these changes.

Critical staffing shortages, supply chain disruptions for drugs and medical supplies, and high inflation rates have driven up hospital costs as they provide around-the-clock patient care. At the same time, hospitals are dealing with insufficient reimbursement increases from government payers and rising administrative burdens due to problematic practices by commercial health insurers.

These combined challenges have created financial uncertainty, leaving many hospitals and health systems operating with greatly reduced profit margins or no profits at all. Although recent data cited in the AHA report indicates a slight stabilization in finances from the historic lows of 2022, the sector is still far from meeting the necessary levels to address care demand, invest in new technologies and interventions, and prepare for future health care crises.

In 2022, the latest year with available data, hospitals admitted nearly 137 million patients to emergency departments and delivered over 3.5 million babies. Many of these critical services are highly resource-intensive and expensive to provide. The situation is further complicated by demographic trends like an aging population and clinical factors such as increased patient acuity. This has led to a steady rise in the proportion of inpatient utilization among more clinically complex patients covered by Medicare and Medicaid. Inpatient services are not only costlier to provide, but public payer payments for these services are significantly below the actual costs.

Some of the alarming developments that the AHA study found include:

• Underpayments from Medicare and Medicaid totaled nearly $130 billion in 2022, and Medicare paid just 82 cents for every dollar hospitals spent caring for patients, which resulted in a shortfall of almost $100 billion.
• Reimbursements for inpatient behavioral health services were 34.3% below costs across all payers on average in 2023, according to data from Strata Decision Technology

• Commercial health insurers have burdened hospitals with time-consuming and labor-intensive practices like automatic claims denials and onerous prior authorization requirements
• A 2021 study by McKinsey estimated that hospitals spent $10 billion annually on dealing with insurer prior authorizations. Furthermore, a 2023 study by Premier found that hospitals are spending just under $20 billion annually appealing denials — more than half which was spent on claims that should have been paid out at the time of submission.
• Costly burn and wound services were 42.9% below costs across all payers.
• Denials issued by commercial MA plans rose sharply by 55.7% in 2023.14 Notably, many of these denials were ultimately overturned.

If your private practice, hospital or healthcare system is being hurt by these developments, then you should consider talking to Coding & Billing Solutions. Our experienced management team and fully domestic coding staff have been helping our clients navigate these difficult challenges through reduced denials and improved coding outcomes.

Contact us today to talk about how CBS can help.