December 2025 Practice Support Newsletter

Coding Corner:
Update: NC Medicaid Rate Reductions

As you may know by now, the NC Medicaid Rate Reductions became effective on October 1, 2025. NC Medicaid posted a bulletin on September 25, which has been subsequently updated on October 30, 2025. In the update, detailed information is given about both the provider rate reductions being implemented by NC Medicaid Division of Health Benefits (DHB) and the applicable services and percentages applied. Please refer to the updated fee schedules and procedure code changes to see how provider practices may be impacted.

NC DHHS provides the following resources as guidance :

Updated NC Medicaid Rate Reduction bulletin (includes a searchable tool to determine the applicable reduction percentage based on the service)
Current Fee Schedules
Online Fee Lookup Tool

Please also remember that the DHB Provider Reimbursement Team medicaid.providerreimbursement@dhhs.nc.gov can help answer any questions or concerns regarding changes to the fee schedule.

Regulatory Reminders:
Finish the Year Strong: Key Steps for Practice Success

The end of the year is the perfect time for practices to conduct a comprehensive assessment. Taking time to review and address key

areas now can set your practice up for success in the new year.

Review Policies and Procedures. Regulatory requirements can come from multiple sources and quickly become overwhelming. To ease this burden, schedule regular policy reviews to ensure compliance and avoid surprises.
Prepare Annual Trainings. Planning annual training sessions before the year end gives your team a head start. This proactive approach ensures staff are ready to meet new challenges and regulatory expectations.
Close Out and Plan Ahead. Wrapping up outstanding tasks and preparing for the upcoming year creates a smoother transition, positioning your practice for growth and efficiency.
The updated Security Risk Assessment Tool (version 3.6) link is up and working (New SRA Tool v3.6 Available) to include:
- Security Risk Assessment Tool | HealthIT.gov

Additional Resources:

Statewide Program for Infection Control and Epidemiology (SPICE)
Occupational Safety and Health Administration (OSHA)
NFPA Life Safety Code
CMS Life Safety Code Requirements
NC DHHS Policies and Manuals (searchable document library)
Guidance on Risk Analysis

Additional Program Reminders:

MIPS Exception Applications and Updates for Program Year 2026

Applications for the Extreme and Uncontrollable Circumstances (EUC) and Promoting Interoperability Hardship exceptions are open until 8:00 PM on December 31, 2025. If external factors affected your ability to meet 2025 program requirements, you may qualify for reweighting some or all performance categories. Review the criteria to determine eligibility.

In addition, providers and practices can view a summary of the 2026 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP) Final Rule which outlines key changes to the MIPS program for 2026. The threshold will be 75 points for 2026. Updates have been made to many sections, with key changes in the Improvement Activities and Promoting Interoperability sections.

CoCM Modules

The Collaborative Care Model (CoCM) is an integrated care model that can be used to treat certain mental health conditions in primary care. Patients are tracked via registry, and the progression of their treatment is monitored. For practices that have applied for the Collaborative Care Model Capacity Building Fund, CoCM modules are still available for continued online learning. Visit this link to register for the modules in the series. Topics include:

Group 1 – The Essentials of Collaborative Care (CoCM Capacity Building Fund req.*)
Group 2 – Collaborative Care Foundations and Team Roles
Group 3 – Collaborative Care Behavioral Care Manager
Group 4 – Operational and Financial Strategies for Sustaining Collaborative Care
Group 5 – Specialized Applications of Collaborative Care for Target Populations
Group 6 - Clinical Skills for Effective Patient Engagement and Intervention
Group 7 – Behavioral Activation (Adult)
Group 8 – Behavioral Activation (Child & Adolescent)
Group 9 – Motivational Interviewing
Group 10 – Exposure Therapy (Child & Adolescent)

NC Tracks Update

“The Case Manager/Care Coordinator taxonomy (171M00000X) has been available to providers as an Organization enrollment type but is intended for Individual provider enrollment only.

The ability for providers to select this taxonomy under an Individual enrollment type will be added to NCTracks and the criterion for enrollment is displayed on the Provider Permission Matrix, available on the NCTracks Provider Enrollment webpage . This includes providers who offer Community Alternatives Program (CAP)-Consumer Direction, CAP for Children and CAP for Disabled Adults services.

Case Manager/Care Coordinators must ensure correct enrollment before March 1, 2026. To ensure correct enrollment, Case Manager/Care Coordinators currently enrolled under Enrollment Type Organization must complete the following steps, as necessary.”

Enrollment instructions for Individual and Organization Providers can be found under the Provider Announcement section of NC Tracks.

AHEC Class Spotlight

Legal and Ethical Foundations of AI in Healthcare

Artificial intelligence (AI) has been a hot topic recently. This course delves into some of the ethical and legal considerations when using artificial intelligence in the healthcare setting. This course is offered as part of the Leadership at Lunch series. This is a live webinar that will be held on January 15, 2026, from noon to 1:00PM. Registration and additional information can be found here on the South Piedmont AHEC website.

The Practice Management Academy Podcast Launch

The North Carolina AHEC Practice Management Academy has launched a podcast series called The Sane Practice Manager. The first episode in the series is entitled “Wisdom for New Practice Managers.” The guest for this

first episode is Matt Johnson, one of the past presidents of Carolinas MGMA.
He is also a Practice Management Academy Boot Camp instructor.