Category Archives: Newsletter

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 to the challenges of USA medical billing.

CMS Releases HCPCS File Conversions for Spanish Translation

CMS has released file conversions related to the Spanish translation of the Healthcare Common Procedure Coding System (HCPCS) medical coding descriptions. The change request provides direction for contractors who need to perform file conversions of HCPCS descriptions from First Coast Service Options quarterly [1].

CY 2026 Hospital OPPS and Ambulatory Surgical Center Proposed Rule

CMS has issued a proposed rule on July 15, 2025. It covers updates to Medicare payment rates and policies that apply to the hospital outpatient and Ambulatory Surgical Center (ASC) services under the Hospital Outpatient Prospective Payment System (OPPS) and the ASC Payment System Proposed rule. The hospital billing policies impact approximately 3,500 hospitals and about 6,100 ASCs [2].

Release of the 2026 Medicare Physician Fee Schedule

July 14, 2025, CMS released a proposed rule that announces and requests public comments on potential policy changes for Medicare payments under the Physician Fee Schedule along with other Medicare Part B topics. These physician revenue cycle management changes would go into effect on or after January 1, 2026 [3].

Humana Cuts Prior Auth Requirements

Humana has sped up its work in reforming their prior authorization process, a change that impacts physician billing services. The company states that, by January 1, 2026, it will eliminate one third of its prior authorization requirements for multiple outpatient diagnostic services, including select CT scans and MRIs, colonoscopies, and transthoracic echocardiograms [4].

Quarterly DME Update

CMS has issued the quarterly update for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Competitive Bidding Program (CBP). These files implement necessary changes to the HCPCS, and ZIP code, as well as single payment amount files. The update impacts home health billing and is issued as of July 21, 2025 [5].

CMS Issues RARC, CARC, MREP, and PC Print Update

The agency has issued a change request that updates the RARC and CARC lists and instructs the ViPS Medicare System (VMS) and the Fiscal Intermediary Shared System (FISS) to update the MREP and the PC Print. The USA medical billing update applies to Chapter 22, Sections 40.5, 60.2, and 60.3 of Publication (Pub.) 100-04 and was issued on July 21, 2025 [6].

Laboratory NCD Edit Software Changes

CMS has published a change request announcing changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2025. It was issued July 21, 2025 and applies to Chapter 16, Section 120.2, Publication 100-04. The full guidance document for medical coding USA is available on the HHS.gov website [7].

Medicare Business Partners Systems Security Manual Update Provided

The Information Security and Privacy Group (ISPG) has issued updated security requirements, specifically the Acceptable Risk Safeguards (ARS). In response, the CMS Medicare Contractor Management Group (MCMG) has updated its Internet Only Manual (IOM) 100-17. More details can be found on the HHS.gov website [8].

NUBC Condition Code “63” Update

Issued July 17, 2025, this HHS change request updates the National Uniform Billing Committee (NUBC) condition code “63”. It allows providers to indicate that services that have been rendered to a prisoner or patient in state or local custody meet requirements under 42 CFR 411.4(b) for payment [9].

HHS Issues Technical Revisions to the CPM

Issued July 15, 2025, this change request announces technical changes to the Claims Processing Manual (CPM), under Publication 100-04, Chapters 18 and 32. The full guidance document for medical coding USA is available for download and review on the HHS website [10].

References

[1] CMS, “File Conversions Related to the Spanish Translation of the Healthcare Common Procedure Coding System (HCPCS) Descriptions,” 29 July 2025. Available: https://www.cms.gov/node/2106216.
[2] CMS, “Calendar Year 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Proposed Rule (CMS-1834-P),” 15 July 2025. Available: https://www.cms.gov/newsroom/fact-sheets/calendar-year-2026-hospital-outpatient-prospective-payment-system-opps-and-ambulatory-surgical.
[3] CMS, “Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule (CMS-1832-P),” 14 July 2025. Available: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-pfs-proposed-rule-cms-1832-p.
[4] J. Emerson, “Humana to cut prior auth requirements, introduce gold card program,” Becker’s Healthcare, 22 July 2025. Available: https://www.beckerspayer.com/payer/humana-to-cut-prior-auth-requirements-introduce-gold-card-program/.
[5] CMS, “Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) – October 2025,” 21 July 2025. Available: https://www.hhs.gov/guidance/document/quarterly-update-durable-medical-equipment-prosthetics-orthotics-and-supplies-dmepos-37.
[6] CMS, “Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update,” 21 July 2025. Available: https://www.hhs.gov/guidance/document/remittance-advice-remark-code-rarc-claims-adjustment-reason-code-carc-medicare-remit-27.
[7] CMS, “Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2025,” 21 July 2025. Available: https://www.hhs.gov/guidance/document/changes-laboratory-national-coverage-determination-ncd-edit-software-october-2025.
[8] CMS, “Pub 100-17 Medicare Business Partners Systems Security Manual Update,” 17 July 2025. Available: https://www.hhs.gov/guidance/document/pub-100-17-medicare-business-partners-systems-security-manual-update.
[9] CMS, “Update of a National Uniform Billing Committee (NUBC) Condition Code “63”, “Incarcerated Beneficiaries,” 17 July 2025. Available: https://www.hhs.gov/guidance/document/update-national-uniform-billing-committee-nubc-condition-code-63-incarcerated.
[10] CMS, “Update of a National Uniform Billing Committee (NUBC) Condition Code “63”, “Incarcerated Beneficiaries,” 17 July 2025. Available: https://www.hhs.gov/guidance/document/technical-revisions-only-claims-processing-manual-cpm-publication-pub-100-04-chapter-18-0.