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 Addresses Coverage for PrEP Drugs
CMS has released a fact sheet on Preexposure Prophylaxis (PrEP). The NCD was initially proposed on July 12, 2023. While medical billing staff should note that there is no coverage change currently, the agency is distributing additional information to minimize disruption if it is finalized [1].

RCM Outsourcing Solves Staffing Issue
A Bay area hospital that had struggled hiring locally qualified staff and that couldn’t afford to invest in software and system upgrades has stepped into outsourcing to revenue cycle management companies. Their primary reason was access to a “highly trained workforce” from a specialized vendor [2].

Quarterly Update for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Released
In medical billing coding news, CMS has published Medicare Claims Processing Transmittal 12584 to replace Transmittal 12553. It covers claims with a DOS on or after January 1 and also adds the following HCPCS Level II codes: A6549, A6584, A6593, and A6609. The codes are added to category 56 [3].

Home Infusion Therapy Rates Updated
In Medicare Claims Processing Transmittal 12570, CMS addresses home infusion therapy (HIT) payment rates as well as instructions for retrieving January 2024 HIT services payment rates through their Mainframe Telecommunications System, a change that can impact healthcare accounts receivable management. The previous transmittal was rescinded and replaced in December 2023 and February 2024 [4]. 

CMS Announces New ICD-10 Codes
The agency has announced the implementation of 41 new procedure codes to be included in the ICD-10-PCS medical coding system. They went into effect April 1, 2024. The software package that accommodates the 41 new codes (Version 41.1) went into effect for discharges on or after April 01, 2024 [5]. 

More Health Systems Outsourcing RCM Functions
Ten health systems are known to have outsourced revenue cycle functions or finance jobs so far this year. These include hospitals in California, Pennsylvania, North Carolina, and Virginia that are working with revenue cycle management companies [6]. 

HCPCS File Download Updated
If anyone on your team regularly uses HCPCS files for medical billing and coding, you should share this update. On the 17th of April, CMS updated the 2024 download link for HCPCS files. The new link is available here [7].  
Implementation Edits on Hospice Claims Published
News for medical coding in the USA reports that CMS has implemented additional edits under the Hospice Certifying Physician Medicare Enrollment for hospice claims. Beginning May 1, the agency started implementing checks that deny a hospice claim if the physician in the Attending field is not listed on the file to enforce the rule [8]. 

Denials by Payment Type Released
A recent report on medical billing denials found that 54% of claims from private payers that were denied were then overturned and paid. The top deniers were commercial payers, followed by Medicare Advantage, and then Managed Medicaid [9]. 

Clarification for Dually Eligible Veterans Released
CMS revised language in Chapter 9 of the Medicare Benefit Policy manual as of April 19. The change replaces the verbiage “Veteran’s eligible beneficiaries” with “dually eligible dually eligible veterans (i.e., eligible for both Medicare and Veterans benefits.” Professionals in physician billing and pediatric medical billing should make note [10].


[1] “Fact Sheet: Potential for Medicare Part B Coverage of Preexposure Prophylaxis (PrEP),” CMS, 15 April 2024. Available: https://cms.gov/files/document/fact-sheet-potential-medicare-part-b-coverage-preexposure-prophylaxis-prep-using-antiretroviral.pdf.
[2] A. Condon, “Oregon hospital plans layoffs amid RCM outsourcing,” Beckers Hospital Review, 23 April 2024. Available: https://www.beckershospitalreview.com/finance/oregon-hospital-plans-layoffs-amid-rcm-outsourcing.html.
[3] “April Quarterly Update for 2024 Durable Medical Equipment, Prosthetics, Orthotics and,” CMS, 1 April 2024. Available: https://www.cms.gov/files/document/r12584cp.pdf.
[4] “CY 2024 Home Infusion Therapy (HIT) Payment Rates and Instructions for Retrieving,” CMS, 17 April 2024. Available: https://www.cms.gov/files/document/r12570cp.pdf.
[5] “ICD-10 MS-DRGs Version 41.1 Effective April 01, 2024,” CMS, 1 April 2024. Available: https://www.cms.gov/files/document/icd-10-ms-drgs-v411-effective-april-1-2024.pdf.
[6] A. Cass, “10 health systems outsourcing RCM functions,” Beckers Hospital Review, 19 April 2024. Available: https://www.beckershospitalreview.com/finance/7-health-systems-outsourcing-rcm-functions.html.
[7] “April 2024 Alpha Numeric HCPCS,” CMS, April 2024. Available: https://www.cms.gov/files/zip/april-2024-alpha-numeric-hcpcs-files.zip.
[8] “Additional Implementation Edits on Hospice Claims for Hospice Certifying Physician,” 19 April 2024. Available: https://www.cms.gov/files/document/r12586cp.pdf.
[9] A. Cass, “Percentage of initial denials overturned, by payer type,” Beckers Hospital Review, 27 March 2024. Available: https://www.beckershospitalreview.com/finance/percentage-of-initial-denials-overturned-by-payer-type.html.
[10] “Manual Updates for Clarification on Services Under the Medicare Hospice Benefit for,” CMS, 19 April 2024. Available: https://www.cms.gov/files/document/r12589bp.pdf.

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