Welcome to Your 2025 Wrapped

If 2025 were a playlist, it would be an epic mix of resilience, innovation, and hard work. As we close out the year, we wanted to take a moment to look back at the "music" we made together.

This year, practice managers and staff across our region didn't just keep the rhythm—you set the tempo for better healthcare in Northwest North Carolina. From navigating complex payer changes to launching new care models, you turned challenges into chart-topping successes.

Here is what your year sounded like, according to the numbers.

📊 The "Minutes Listened" (Our Impact by the Numbers)

You were incredibly busy this year. While much of the healthcare world was just tuning in, you were logging serious hours to improve access and quality.

• Total Practice Coaching Encounters: 2,297
  • That represents nearly 2,300 specific touchpoints where we worked side-by-side with you to solve problems and improve care.
• Top Region on the Charts: Ashe County ⛰️
  • Ashe County was our "Top Artist" this year with 164 encounters, proving that rural health remains the heartbeat of our region.
• The Rising Hits:
  • Alleghany and Alexander counties also topped the setlist, keeping the momentum strong across our footprint.

🎹 Your Top Genre: Medicaid Managed Care

If 2025 had a main genre, it was definitely Medicaid Managed Care.

Just like in previous years, this was the beat driving most of our work. Whether it was deciphering the Standardized Performance Incentive Program or navigating Advanced Medical Home (AMH) tier support, you stayed in sync with the state's biggest changes.

Your Top Sub-Genres (Trending Topics):

• Billing & Coding: The technical solos that kept your revenue cycle moving.
• Practice Management Operations: The daily rhythm of running an efficient office.
• Quality Payment Program (QPP): The critical performance reviews that ensured you got credit for your quality care.

💿 The "Viral Hits" (Top Stories of 2025)

Every year has those standout tracks that everyone talks about. These were the success stories and resources that defined 2025 for our network.

• The Story: Facing a surge in mental health needs, the team at Twin City Pediatrics implemented the Collaborative Care Model (CoCM).
• The Result: By June 2025, they didn't just launch—they became revenue-positive six months ahead of schedule. It was the feel-good hit of the summer and a blueprint for others to follow.

 The Indie Favorite: Fall Risk Assessment 

• The Story: Released in June, the self-paced course Falls: Screening, Risk Assessment and Care Planning became an instant essential for clinicians working with older adults.
• The Vibe: Since its debut on 6/16/25, it has racked up 223 registrations. By focusing on the STEADI framework, you proved that keeping patients safe and steady is a timeless classic that never goes out of style.

• The Story: With the announcement that the Clear Pricing Project ends on Dec 31, 2025, we shifted focus to transition planning.
• The Shift: You worked hard to prepare for the move away from CPP and into new fee schedules for 2026, ensuring your practices remain financially stable during the switch.

🔮 Your "Musical Aura" for 2026

Based on your listening habits late in the year, 2026 is shaping up to be a year of Innovation & Resilience.

We are already queuing up tracks on AI in Clinical Decisions, Cybersecurity, and leveraging the newly relaunched NC AHEC Digital Library. The setlist for next year is going to be exciting, and we can't wait to explore it with you.

Thank you for a chart-topping 2025!

Here’s to keeping the beat going in the New Year.

— The NW AHEC Practice Support Team

Need help planning your 2026 playlist? Reach out to us at practicesupport@wakehealth.edu.

Are you a new or aspiring practice manager, or a provider interested in learning more about practice management? The NC AHEC Practice Management Academy is your gateway to professional growth, networking, and leadership development.

Practice Manager Boot Camp: Leadership Module

Spaces are still available for the Leadership module, starting January 2026!

• Dates: Thursday, January 8, 2026 – Monday, March 9, 2026
• Time: 3:00 PM – 4:00 PM
• Format: Virtual Classes (9 Contact Hours)
• Registration: https://www.southernregionalahec.org/courses-and-events/75763
• Registration closes: January 7, 2026
• Fee: Register by 12/8: $180 | After 12/8: $225

Who Should Attend?

• New and aspiring practice managers
• Providers interested in practice management
• Anyone seeking to enhance leadership and management skills

What You’ll Learn

Week-by-week topics include:

• Braveheart Leadership: Characteristics of inspirational leaders, personal strengths and growth opportunities
• Becoming an Authentic Leader: Impact of gender and implicit bias, authentic leadership styles
• Understanding & Building Your Team: Emotional intelligence (EQ) vs. intelligence quotient (IQ), team dynamics
• Vampires in the Workplace: Identifying and managing toxic staff
• Effective Communication: Professionalism, conflict cycles, and resolution
• Managing Conflict: Power dynamics, critical conversations, crisis communication
• Retaining Effective Employees: Creating a constructive work environment
• Mentoring Physician Leadership: Strategies for orienting provider-leaders, collaboration
• How to Run a Meeting: Structured agendas, facilitation, best practices, and formal meeting structures

Speakers

• GeGe Beall (MS, FACHE, SPHR, SHRM-SCP): Expert in industrial/organizational psychology and HR/organizational development
• Matt Johnson (BA, MA, MBA): Experienced practice administrator, NC Medical Group Management Association board member
• Jane Moran (BA, MLS): Project Specialist, NCAHEC Practice Management Academy, customer service and education expert
• Melissa Overton (BSN, RN, CEO): Award-winning educator, mentor, and CEO of MedicalTraining.me

Why Join the Practice Management Academy Community?

• Free Membership: Access free courses, news, and networking opportunities
• Professional Development: Learn and register for upcoming courses
• Networking: Connect with other practice managers and providers

From the CMS QPP Updates Newsletter:

North Carolina Medicaid provider reimbursement rate reductions go into effect October 1, 2025.

The reduction percentages vary from 3%,  8% or 10% and apply to procedure codes.

NC Medicaid plans to publish detailed updated fee schedules to the NC Medicaid Covered Codes and Fee Schedules Portal. You are advised to check back frequently for these updated documents. 

North Carolina Division of Health Benefits officially notified Vaya Health of upcoming changes to the NC Medicaid fee schedule rates effective October 1, 2025. The new detailed fee schedule changes have not yet been provided.

Vaya Health notified network providers in their recent bulletin that it will update their systems to implement the fee schedule changes no earlier than November 1, 2025.  If there is no legislative agreement by October 31, Vaya will implement the rate cuts on November 1, retroactive to the effective date of October 1.  On that date they plan to update their systems to pay at the newly published rates, and will take steps to recoup the difference in reimbursement for services provided back to October 1.

Vaya indicated they will issue more detailed communications soon, and provided links to email them with questions as well as a link to join the Vaya Provider Touchpoint webinar on October 3rd.

Source: https://providers.vayahealth.com/bulletins/

NC Medicaid, in collaboration with the five NC Medicaid Managed Care Standard Plans, hosts the...

Fifth Annual Virtual Statewide Quality Forum

Wednesday, October 8 from noon-1:30 p.m.

Topics will include:

• Administrative Simplification Workgroup Updates
• Early Intervention and EPSDT: Proven Strategies for Success – Feedback from Providers 
  and Standard Plans
• Key Updates from NC Medicaid

The forum is designed for providers, practice managers, and quality managers to engage in 
focused discussion about how to successfully apply Medicaid Managed Care quality initiatives to 
generate positive outcomes.

Please register to participate in this valuable and informative forum that will offer practical 
applications to enhance and improve your services to NC Medicaid members.

Several health insurance companies in North Carolina have recently implemented programs to review claims and codes that results in the down coding of Level 4 and Level 5 Evaluation and Management (E/M) claims.

According to the North Carolina Medical Society, Aetna's process does not target all Level 4 and 5 codes, nor does it include all providers within the state. However, there remains confusion about why the insurer has implemented this program. Cigna's approach is broader and applies to all physicians and to six E/M codes: 99204-99205 (new patient), 99214-99215 (established patient), and 99244-99245 (consult for new & established patients). Cigna will implement this review nationally on October 1, 2025.  

Along with the North Carolina Medical Society, many professional societies across the country are also alerting their members to this issue. 

It is critical to follow the appropriate appeals process for any claims you believe to be inappropriately down coded! 

WEBINAR

Virtual Office Hours

STAY IN THE KNOW: Key NC Medicaid Updates for Provider Office Staff

Thursday, September 4 | noon - 1 p.m.

Please join us on Thursday, September 4 from noon-1 p.m. for an informative Virtual Office Hours webinar to get updates and hear the latest statuses on hot program topics that are impactful to the provider community! Get the insights and resources you need to navigate upcoming developments with NC Medicaid. 

Webinar topics will include:

• EPSDT: Pay and Chase
• Carolina ACCESS Enrollment Refresher
• Maintaining Eligibility Program
• Children and Family Specialty Program – Provider Contracting
• Credentialing Committee Updates
• Avoid Common Enrollment Application Issues Cont’d
• Key Resource: NC Medicaid Provider Ombudsman

Register by clicking the blue button below. We look forward to connecting with you!

At this time, there’s been no indication that the Clear Pricing Project (CPP) will be extended or replaced for primary care. The only new program announced so far is the Behavioral Health Access Program (BHAP), which does not apply to primary care providers.

That said, here are a few proactive steps you can take:

• Review your current contracts with Aetna to understand how your reimbursement rates may change once CPP ends.
• Consider renegotiating your contract. Many practices are already doing this to secure more sustainable terms.
• Ensure you’re part of Aetna’s Choice POS II network, which the NC State Health Plan will use exclusively starting January 1, 2025.
  
  👉 Join the Aetna Network
  👉Behavioral Health Access Program(BHAP)

Today we bring you updates from the latest CMS QPP Newsletter for Small Practices:

CMS Proposes Policy Changes for Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) has issued its Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule, which includes proposed policies for the Quality Payment Program (QPP).

The Notice of Proposed Rulemaking (NPRM) includes proposals for the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs), as well as several Requests for Information (RFIs).

Specifically, we’re proposing policies that:

• Continue the transformation of MIPS through MIPS Value Pathways (MVPs).
• Are responsive to feedback and concerns raised by interested parties.
• Maintain stability within the MIPS program through the established performance threshold.

2026 Policy Proposal Highlights

Key QPP policies that we are proposing in the CY 2026 PFS Proposed Rule include:

• Introducing 6 new MVPs for the 2026 performance year that are related to diagnostic radiology, interventional radiology, neuropsychology, pathology, podiatry, and vascular surgery.
• Introducing a 2-year informational-only feedback period for new cost measures, allowing clinicians to receive feedback on their score(s) and find opportunities to improve performance before a new cost measure affects their MIPS final score.
• Maintaining the current performance threshold policies, leaving the performance threshold set at 75 points through the 2028 performance year.
• Introducing Qualifying APM Participant (QP) determinations at the individual level, in addition to existing determinations at the APM entity level.

Overview of RFIs

We are also seeking feedback on RFIs about the following topics:

• Establishing Core Elements for MVPs, to require reporting on key quality measures within each MVP.
• Establishing a process to assign clinicians to an MVP, to facilitate the most relevant reporting for their scope of care.
• Transitioning to FHIR-based electronic clinical quality measure (eCQM) reporting in quality reporting programs.
• Understanding the current environment, including challenges, with collecting and exchanging high-quality healthcare data.
• Changing requirements for the Query of Prescription Drug Monitoring Program (PDMP) Measure and Performance-Based Measures in the Public Health and Clinical Data Exchange Objective.