May 2025 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 . 

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].