We’ve assembled the latest news for healthcare revenue cycle leaders to help you stay on top of industry challenges and adapt your revenue cycle management services.
CMS Releases 2025 Codes for Medical Billing and Coding
CMS has released a code list that goes into effect January 1, 2025. This list includes medical billing and coding revisions that are effective for the same calendar year. The agency is also accepting comments at www.regulations.gov under docket number CMS-2024-0301 [1].
Potential Collaboration Between ICD-11 and SNOMED CT
The World Health Organization has announced that they are in the process of exploring a joint sustainable framework that would link SNOMED CT and ICD-11. The goal is to “facilitate a seamless data conversation and linkages” for anyone using both systems with the goal of moving toward improved medical billing interoperability [2].
CMS Revisions to Chapter 12
CMS has released a change request to revise sections 12.9 and 12.13 in Pub. 100-08, Chapter 12. These changes are effective December 17, 2024 and implemented on that same date. These changes fall under transmittal 12959 [3].
Improper Payments Fact Sheet for USA Medical Billing
CMS has released its improper payments fact sheet for 2024, a summary of payments that do not meet CMS program requirements in USA medical billing. These payments fall under the class of payments that do not represent fraud or abuse, including medical billing underpayments, overpayments, or payments with insufficient information to determine validity [4]. These changes impact much of USA medical billing practices.
Changes to ESRD PPS
CMS released a change request addressing the implementation of changes to the End-Stage Renal Disease Prospective Payment System and Payment for Dialysis Furnished for Acute Kidney Injury in ESRD Facilities. These changes go into effect January 1, 2025 and will be implemented January 6, 2025 [5]. These changes could impact hospital accounts receivable around the country.
Oncology Changes Coming in 2025 for Physician Coding and Medical Billing
Oncology practices have CPT changes to stay on top of in 2025 in their physician coding and medical billing. The AMA released 420 changes for next year, with a few directly impacting oncology coding including CAR T-Cell therapy codes, new prostate and thyroid nodule ablation codes, intra-abdominal tumor excision, and new autologous skin cell transplant [6].
CMS Revises Internet Only Manual
CMS has issued a change request that revises chapters 3, 4, 12, and 32 of Publication 100-04. This pertains to the Claims Processing Manual in the Internet Only Manual (IOM) and removes obsolete language related to the Medicare FFS systems claim edits. It went into effect October 1, 2024 and is implemented as of December 17, 2024 [7].
Medicare Parts A and B Premiums and Deductibles Announced
CMS has released information on 2025 premiums, deductibles and coinsurance amounts for Medicare Part A and Part B programs as well as the 2025 Medicare Part D income-related monthly adjustment amounts. Amounts are determined under the provisions of the Social Security Act [8]. These changes could impact home health billing.
REH Payment Amount Updated for Medical Billing
CMS has released a change request updating the Rural Emergency Hospital monthly facility payment amount in 2025. This medical billing update goes into effect January 1, 2025 and is implemented as of January 6, 2025 [9].
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References
[1] CMS, “List of CPT/HCPCS Codes,” 26 November 2024. Available: https://www.cms.gov/medicare/regulations-guidance/physician-self-referral/list-cpt-hcpcs-codes.
[2] WHO, “WHO explores collaboration with SNOMED International for linkage between ICD-11 and SNOMED CT,” 22 October 2024. Available: https://www.who.int/news/item/22-10-2024-who-explores-collaboration-with-snomed-international-for-linkage-between-icd-11-and-snomed-ct.
[3] CMS, “CMS Manual System Transmittal 12959 Change Request 13842,” 14 November 2024. Available: https://www.cms.gov/files/document/r12959pi.pdf.
[4] CMS, “Fiscal Year 2024 Improper Payments Fact Sheet,” 15 November 2024. Available: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2024-improper-payments-fact-sheet.
[5] CMS, “CMS Manual System Transmittal 12962 Change Request 13865,” 14 November 2024. Available: https://www.cms.gov/files/document/r12962bp.pdf.
[6] T. Kim, “Big Oncology Changes in CPT 2025: Oncologists Should Watch for These Codes,” HealthCentral LLC, 1 October 2024. Available: https://www.oncologynewscentral.com/article/big-oncology-changes-in-cpt-2025-oncologists-should-watch-for-these-codes.
[7] CMS, “CMS Manual System Transmittal 12961 Change Request 13854,” 14 November 2024. Available: https://www.cms.gov/files/document/r12961cp.pdf.
[8] CMS, “2025 Medicare Parts A & B Premiums and Deductibles,” 8 November 2024. Available: https://www.cms.gov/newsroom/fact-sheets/2025-medicare-parts-b-premiums-and-deductibles.
[9] CMS, “CMS Manual System Transmittal 12964 Change Request 13872,” 15 November 2024. Available: https://www.cms.gov/files/document/r12964cp.pdf.
