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 Fiscal Year 2025 Code Update Files
The Agency has released files for FY 2025. This hospital coding should be used for discharges from October 1, 2024 to September 30, 2025. They are also used for patient encounters from October 1, 2024 to September 30, 2025 [1].
CMS Publishes Quarterly Update to NCCI PTP Edits
CMS has released Medicare Claims Processing Transmittal 12842, covering the quarterly update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits. This is version 31.0 that goes into effect January 1, 2025. The final file is expected to be available around November 15, 2024 [2].
DSH Hospital Update
Via the Medicare Learning Network, CMS has published the Medicare Disproportionate Share (DSH) Hospital fact sheet. This hospital revenue cycle document contains additions from the fiscal year 2024 IPPS final rule. The most important changes are highlighted in dark red [3].
COVID Vaccine Prices Updated
As of September 10, 2024, CMS has updated its vaccine pricing page, including both COVID and Influenza. It affects medical coding in USA and covers Part B payment allowances for the flu and information on deductible and coinsurance amounts. The page also includes Part B payment details for COVID-19 vaccines and certain monoclonal antibodies [4].
CMS October Update for HCPCS Files
CMS has issued updates to the HCPCS as public use files, updated September 11, 2024. The file title is “October 2024 Alpha-Numeric HCPCS File (ZIP)” and is the most recent posted update since June 10, 2024 [5].
CMS Quarterly Update for DMEPOS Fee Schedule
Under Medicare Claims Processing Transmittal 1835, CMS has released updates for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) final rule. The update includes 22 new codes and 13 new fee schedule amounts. There were no deleted codes to impact home health care billing [6].
Update for HPSA Bonus Payments
CMS has released the 2025 annual update for the Health Professional Shortage Area (HPSA) Bonus Payments under Medicare Claims Processing Transmittal 12837. The change request provides files for automated payments of HPSA bonuses for dates of services between January 1, 2025 through December 31, 2025 [7].
Four States Expanding Hospice Benefit Prepayment Review
In an effort to counter abuse, waste, and fraud committed under the hospice benefit, CMS is expanding prepayment and medical review in four states. These include Arizona, California, Nevada and Texas. Noncompliance for this level of USA medical billing may result in extended review or additional administrative actions [7].
ASC Payment System Update
Under Medicare Claims Processing Transmittal 12824, CMS has released the October 2024 update for the Ambulatory Surgical Center Payment system. This change request provides changes to medical billing instructions for and changes to a range of payment policies that were implemented under the October 2024 ASC payment system update [8].
Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update
This request identifies changes to HCPCS codes and additionally explains how physician fee schedule designations will allow A/B Medicare Administrative Contractors (MACs) to make appropriate payments by revising Common Working File (CWF) edits [9]. Medical billing companies should also be aware of this update.
You can review our last newsletter here.
References
[1] CMS, “ICD-10,” 26 September 2024. Available: https://www.cms.gov/medicare/coding-billing/icd-10-codes#CodeFiles.
[2] CMS, “CMS Manual System Transmittal 12842 Change Request 13798,” 11 September 2024. Available: https://www.cms.gov/files/document/r12842cp.pdf.
[3] CMS, “Medicare Disproportionate Share Hospital,”. Available: https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/disproportionate_share_hospital.pdf.
[4] CMS, “Vaccine Pricing,” 27 September 2024. Available: https://www.cms.gov/medicare/payment/part-b-drugs/vaccine-pricing.
[5] CMS, “HCPCS Quarterly Update,” 11 September 2024. Available: https://www.cms.gov/medicare/coding-billing/healthcare-common-procedure-system/quarterly-update.
[6] CMS, “CMS Manual System Transmittal 12835 Change Request 13774,” 12 September 2024. Available: https://www.cms.gov/files/document/r12835cp.pdf.
[7] CMS, “CMS Manual System Transmittal 12837 Change Request 13789,” 13 September 2024. Available: https://www.cms.gov/files/document/r12837cp.pdf.
[8] CMS, “Hospice Benefit: Expanding Prepayment Review in 4 States,” 5 September 2024. Available: https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-09-05-mlnc#_Toc176264802.
[9] CMS, “CMS Manual System Transmittal 12824 Change Request 13800,” 5 September 2024. Available: https://www.cms.gov/files/document/r12824cp.pdf.
[10] CMS, “CMS Manual System Transmittal 12827 Change Request 13786,” 6 September 2024. Available: https://www.cms.gov/files/document/r12827cp.pdf.
