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 Eyes Closing Medicaid Loophole
CMS has issued a proposed rule intended to close a loophole in Medicaid that they report has been used by states to inflate federal payments. The rule would bar states from taxing Medicaid businesses at rates that are higher than non-Medicaid businesses, provide a transition timeline based on the age of existing waivers, among other allowances [1].
Quarterly Update to Physician Fee Schedule Database Available
Under transmittal R13213CP, CMS has issued the Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – July 2025 Update. This change to physician billing services is implemented as of July 7, 2025 and is available for download on the CMS website [2].
HCPCS Quarterly Update is Available
Updated 5/13/2025, the July 2025 Alpha-Numeric HCPCS File (ZIP) is available for download. It can be accessed on the CMS website along with prior files going back to 2021 by those with needs in medical billing and medical coding.
Updates to Opioid Use Treatment Manual
The American Academy of Family Physicians has updated the manual, Treating Opioid Use Disorder as a Chronic Condition. These updates include changes to payment and coding tables under physician revenue cycle management [3].
IPPS and LTCH PPS Proposed Rule
CMS has released a proposed rule that updates Medicare payment policies for the hospital inpatient PPS and Long-Term Care Hospital Prospective Payment System proposed rule for fiscal year 2026 in the hospital revenue cycle. More details on the rule, including background, changes, and transition for the discontinuation of the Low Wage Index Hospital Policy are available on the CMS website [4].
CMS Releases New Cost Report Data
New cost report data is available, updated March 31, 2025 and released April 17, 2025. The information is based on data reported by the Healthcare Cost Report Information System (HCRIS) and impacts home health billing and hospital billing and coding [5].
Request for Public Input on Inpatient Hospital Whole-Person Care
CMS has issued a proposal for a rule that would update payments and policies for long-term care and inpatient hospitals. The agency has requested public input on how to improve the quality of care provided by inpatient hospitals. The rule has a 60-day comment period that is open to providers, payers, and any medical billing company in USA [6].
ICD-11 Updates Released
The World Health Organization has announced its release of the 2025 edition of ICD-11 coding which impacts medical coding in USA. The update includes new features, improved error detection, multilingual expansion, and a module that covers traditional medicine conditions of Ayurveda and other related traditional medicine systems [7].
Home Health Grouper Quarterly Update
CMS has released Change Request 14067, which provides updates to the Home Health Grouper software. This home health care billing update is implemented as of October 6, 2025 and falls under Transmittal 13214 [8].
DHHS Releases Updates to Medicare Processing Manual
CMS has published updates to the Medicare Summary Notice (MSN) envelopes in the Medicare Claims Processing Manual for revenue cycle management services. This update is effective as of October 1, 2025 and implemented as of October 6, 2025 [9].
FDA Releases Clinical Laboratory Improvement Amendments
CMS has released Transmittal 13218, informing contractors of new Clinical Laboratory Improvement Amendments of 1988 (CLIA) waived tests approved by the Food and Drug Administration. This change is effective as of July 1, 2025 and implemented as of July 7, 2025 [10].
References
[1] CMS, “CMS Moves to Shut Down Medicaid Loophole—Protects Vulnerable Americans, Saves Billions,” 12 May 2025. Available: https://www.cms.gov/newsroom/press-releases/cms-moves-shut-down-medicaid-loophole-protects-vulnerable-americans-saves-billions.
[2] CMS, “CMS Transmittal 13213 Change Request 14074,” 9 May 2025. Available: https://www.cms.gov/files/document/r13213cp.pdf.
[3] AAFP, “Academy Updates Opioid Use Disorder Treatment Manual,” 24 March 2025. Available: https://www.aafp.org/news/health-of-the-public/opioid-use-disorder-manual.html.
[4] CMS, “FY 2026 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Proposed Rule — CMS-1833-P Fact Sheet,” 11 April 2025. Available: https://www.cms.gov/newsroom/fact-sheets/fy-2026-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective.
[5] CMS, “Cost Reports,” 18 April 2025. Available: https://www.cms.gov/data-research/statistics-trends-and-reports/cost-reports.
[6] CMS, “CMS Seeks Public Input on Inpatient Hospital Whole-Person Care, Proposes Updates to Medicare Payments Payment Rules,” 11 April 2025. Available: https://www.cms.gov/newsroom/press-releases/cms-seeks-public-input-inpatient-hospital-whole-person-care-proposes-updates-medicare-payments.
[7] WHO, “WHO releases 2025 update to the International Classification of Diseases (ICD-11),” 2025, 14 February. Available: https://www.who.int/news/item/14-02-2025-who-releases-2025-update-to-the-international-classification-of-diseases-(icd-11).
[8] CMS, “Quarterly Update to Home Health (HH) Grouper,” 9 May 2025. Available: https://www.hhs.gov/guidance/document/quarterly-update-home-health-hh-grouper-14.
[9] CMS, “Update to Publication 100-04 Medicare Claims Processing Manual Chapter 21 Medicare Summary Notices (MSN) English Exhibits for Envelope Changes Described in Previously Issued Change Request,” 8 May 2025. Available: https://www.hhs.gov/guidance/document/update-publication-100-04-medicare-claims-processing-manual-chapter-21-medicare-summary.
[10] MS, “New Waived Tests,” 9 May 2025. Available: https://www.hhs.gov/guidance/document/new-waived-tests-92.
