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.
New Telemedicine Codes Released for 2025
17 new telemedicine codes have been issued for CPT® 2025. It includes 270 new codes, of which, 17 are telemedicine codes. The code ranges are 98000-98016 and go into effect January 1, 2025. Telephone E/M codes have been deleted (99441-99443) [1]. This change has the potential to impact pediatric medical billing, home health care billing, and revenue cycle management companies across the country.
Payers Take a Step Back on 2-Midnight Rule
Some payers are taking their own stance on the two-midnight rule used for Medicare beneficiaries. These payers are using their own criteria for inpatient admission. Hospital coding leaders are recommended to monitor payer behavior for observation across all their lines of business [2].
Revisions to the CoP Requirements for Hospitals and CAHs Released
CMS has issued hospital coding revisions to the Condition of Participation requirements for hospitals and CAHs in their reporting of acute respiratory illnesses. These revisions impact “Medicare and Medicaid Programs and the Children’s Health Insurance Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2025 Rates; Quality Programs Requirements; and Other Policy Changes” [3].
CMS Announces Changes to ACO PC Flex Model
CMS has issued a change request to establish system changes implementing the ACO Primary Care First Model. It is effective April 1, 2025 and the implementation date is April 7, 2025. Details can be found under Change Request 13609. Since this can impact home health coding, hospital accounts receivable, and physician billing services, all providers that are members of ACOs should consider this update in their medical billing [4].
Payment Reduction Changes for LTCHs
CMS has issued a Change Request that updates the language for the Long-Term Care Hospital 2% payment reduction process. The document has been revised to specifically align language across Post-Acute Care settings for the designated data submission system used by CMS [5]. This change will be pertinent for a range of healthcare accounts receivable management leaders.
Eligibility and Enrollment Changes for Insurance Affordability Programs
CMS has announced its intent to replace the processes and technology that supports coordination of eligibility and enrollment for insurance affordability programs. This is a requirement under the Social Security Act, section 1943. This update is pertinent for any provider that accepts Marketplace plans and has to consider how changes impact medical billing and coding [6].
Waivers for Hurricane Milton Available
CMS has updated its Emergencies Web Page with new information on blanket waivers along with other flexibilities that have been made available to Florida counties that were impacted by Hurricane Milton. The waivers are effective through the end of the Hurricane Milton public health emergency or until they are not necessary [7]. This impacts medical coding in USA, the state of Florida.
Small Independent Hospitals Subject to Updates to Claims Processing System
CMS has released Processing Transmittal 12615 in USA medical billing pertaining to updates to the system preparing for a separate payment under the IPPS to small independent hospitals. These updates pertain to the cost of establishing and maintaining access to buffer stock of essential medicines. The changes go into effect October 1, 2024 [8].
Final Rule Establishes Appeals Processes for Reclassified Inpatients
CMS has released a medical billing final rule that establishes an appeals process for patients with Medicare who are first admitted as an inpatient but who are then reclassified as outpatients. The rule implements a federal court order. The agency has provided more information on the final rule and the court order [9].
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References
[1] CMS, “Notice of Technology and Process Upgrades for Account Transfer Functionality for States Served by Marketplaces on the Federal Platform,” 10 October 2024. Available: https://www.medicaid.gov/federal-policy-guidance/downloads/cib10102024.pdf.
[2] A. Cass, “Some payers are ‘hitting the snooze button’ on 2-midnight rule: Report,” Becker’s Healthcare, 23 October 2024. Available: https://www.beckershospitalreview.com/finance/some-payers-are-hitting-the-snooze-button-on-2-midnight-rule-report.html.
[3] CMS, “Updates to the Condition of Participation (CoP) Requirements for Hospitals and Critical Access Hospitals (CAHs) To Report Acute Respiratory Illnesses,” 22 October 2024. Available: https://www.cms.gov/files/document/qso-25-05-hospitals-cahs.pdf.
[4] CMS, “CMS Manual System Transmittal 12907 Change Request 13609,” 24 October 2024. Available: https://www.cms.gov/files/document/r12907demo.pdf.
[5] CMS, “CMS Manual System Transmittal 12900 Change Request 13256,” 24 October 2024. Available: https://www.cms.gov/files/document/r12900qri.pdf.
[6] CMS, “Notice of Technology and Process Upgrades for Account Transfer Functionality for States Served by Marketplaces on the Federal Platform,” 10 October 2024. Available: https://www.medicaid.gov/federal-policy-guidance/downloads/cib10102024.pdf.
[7] CMS, “Current emergencies,” 8 November 2024. Available: https://www.cms.gov/about-cms/what-we-do/emergency-response/current-emergencies.
[8] CMS, “CMS Manual System Transmittal 12615 Change Request 13590,” 2 May 2024. Available: https://www.cms.gov/files/document/r12615cp.pdf.
[9] CMS, “Medicare Appeal Rights for Certain Changes in Patient Status Final Rule (CMS-4204-F) Fact Sheet,” 11 October 2024. Available: https://www.cms.gov/files/document/medicare-appeal-rights-certain-changes-patient-status-final-rule-fact-sheet.pdf.
