September 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. 

UnitedHealth Criminal Probe Widens

Becker’s has reported that the Justice Department is expanding criminal investigations into UnitedHealth Group and its examination of pharmacy benefit manager, Optum Rx. Previously, the investigation covered Medicare Advantage fraud and also a civil fraud investigation into Medicare medical billing practices [1].

HCPCS Quarterly Update Available

CMS has released the official update of the HCPCS medical coding system. It is available as a public file under the name: October 2025 Alpha-Numeric HCPCS File (ZIP) [2].

OIG Releases Report on Remote Patient Monitoring for Medicare

Seeing the potential of remote patient monitoring services in expanding an increasingly impacting USA medical billing, OIG has insisted that additional oversight of remote patient monitoring is necessary. The report found that use has continued to grow and that billing monitoring can help protect the Medicare program as use increases [3].

AMA Issues AI Adoption Guidance: Helpful for Healthcare Revenue Cycle Solutions Research

The American Medical Association has issued a guide on developing AI policies that are supportive of organizational needs – a guide for any healthcare leaders researching AI healthcare revenue cycle solutions. It covers what to include, evaluating existing policy, and insight into advocacy principles [4]. 

Poll Reflects American Opposition to CMS Cuts to Home Health

A poll from the National Alliance for Care at Home revealed that 70% of Americans are opposed to CMS’ 2026 Medicare home health proposed rule. The rule would cut Medicare home health funding by $1.1 billion next year, potentially impacting home health billing [5].

Cigna’s New Downcoding Policy Gets Push Back from Medical Associations

Cigna’s new Evaluation and Management Coding Accuracy Policy is being met with negative response from medical associations in California and Texas. They are pushing Cigna to rescind the policy with the argument that it will increase medical coding administrative burden and hamper reimbursement [6].

KFF Summarizes Health Provisions in 2025 Reconciliation Bill

KFF has issued a summary of the healthcare provisions from the 2025 federal budget reconciliation law. The tool offers side-by-side comparison in the House- and Senate-passed reconciliation law to each other and to prior law. Comparison is available for Medicaid, the ACA, Medicare and HSAs, impacting medical billing, coding, and healthcare in the country [7].

No Surprises Medical Billing Disputes Cost $5 Billion

A Health Affairs study has revealed a startling cost of the independent dispute resolution process. The report cites a high volume of medical billing disputes resulting in significant spending on administrative costs and higher payments for services. Total estimated costs reach at least $5 billion [8].

Boost CAHPS Scores With Supervisory Training

Home Health Care News reports that home health agencies with higher employee engagement and retention tend to experience high patient and caregiver satisfaction scores. The report revealed that supervisory training had a positive impact on specific care issues and patients recommending the agency [9]. It’s a good document to review for home health care billing leaders.