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.
Home Health Industry Threatened by Shutdown
The recent government shutdown is causing problems for the home health industry and home health care billing, pushing it over a telehealth cliff, limiting its patient pool, and adding administrative burden, according to Home Healthcare News. It’s also frozen the Acute Hospital Care at Home (AHCAH) program [1].
Risk Adjustment Audit Overhaul Struck Down
A federal judge in Texas has ruled that DHS violated the Administrative Procedure Act, failing to appropriately notify industry stakeholders and the general public about the changes in the medical coding audit rule. The suit was brought by Humana, challenging the September 2023 RADV overhaul. The ruling is being counted as a significant win for payers [2].
CMS Expects Medicare Advantage and Medicare Prescriptions Drug Programs to Remain Stable
The agency has announced that the average plan choices, premiums, and benefits for the MA program and Part D prescription drug program will be stable in 2026. Average premiums are expected to decline in both programs. CMS is releasing this information ahead of Medicare Open Enrollment [3].
Lab Developed Test Final Rule Rescinded
The FDA rescinded the final rule on laboratory developed tests. This action puts a formal end to a long-term effort to increase oversight in the industry. The agency has issued a new final rule, changing the definition of in vitro diagnostics to align with pre-2024 regulations [4]. Healthcare providers and medical billing companies should keep an eye out for changes that impact them.
HCPCS Quarterly File Updated
The previously released HCPCS quarterly update for October has been updated as of 9/23/2025. The medical billing updates can be reviewed and downloaded by the public on the CMS website under the file name: October 2025 Alpha-Numeric HCPCS File (ZIP) [5].
E/M Billing and Coding Updates Released by CMS
CMS has published a revised MLN booklet, covering E/M services. This update concerns billing and medical coding updates for home or residence services, telehealth services, hospital outpatient clinic visits, critical care services, and more [6].
The Impact of Federal Funding Cuts on Health Systems
Becker’s Hospital Review has published an overview of the impact of the One Big Beautiful Bill Act to multiple areas of healthcare including Medicaid reductions, ACA subsidies, Medicare Advantage, 340B drug pricing programs, and NIH funding [7].
New ICD-10-CM Codes Announced
CMS has announced new ICD-10-CM codes that are effective October 1, 2025 for revenue cycle management services. These codes will impact discharges from October 1, 2025 to September 30, 2026. They will also impact patient encounters between October 1, 2025 and September 30, 2026 [8].
Humana to Pay $32M in Fees in False Claims Settlement
Humana has been ordered by a federal court to pay over $32 million in fees, including attorney’s fees, costs, and interest connected with the resolution of a False Claims Act case from 2024. The lawsuit was filed in 2016 by a former actuary for Humana who claimed that the company sent CMS fraudulent bids for the Walmart Part D prescription drug plan [9].
The AHA Pursues Commitments on Prior Auth Reforms
The American Hospital Association has encouraged HHS leadership to keep the promises they’ve made on prior authorization reforms for the hospital revenue cycle. The association sent a letter to CMS and HHS leaders, emphasizing the fact that 95% of hospitals report that staff time spent on prior auth approval has increased in the last year, increasing patient frustration and burden on providers [10].
New Epic Interoperability Features
Epic has launched multiple new data-sharing features at a recent interoperability conference. They include more prior authorization APIs, MyChart changes, and updates to align with federal interoperability standards [11].
References
[1] M. Gonzales, “Government Shutdown Halts Telehealth Flexibilities, Hospital-at-Home Waiver, Threatening Home Health Industry,” Home Health Care News, 1 October 2025. Available: https://homehealthcarenews.com/2025/10/government-shutdown-halts-telehealth-flexibilities-hospital-at-home-waiver-threatening-home-health-industry/.
[2] P. Minemyer, “Federal judge strikes down 2023 risk adjustment audit overhaul in win for Medicare Advantage plans,” Fierce Healthcare, 26 September 2025. Available: https://www.fiercehealthcare.com/payers/federal-judge-strikes-down-2023-radv-audit-overhaul-win-medicare-advantage-plans.
[3] CMS, “Medicare Advantage and Medicare Prescription Drug Programs Expected to Remain Stable in 2026,” 26 September 2025. Available: https://www.cms.gov/newsroom/press-releases/medicare-advantage-medicare-prescription-drug-programs-expected-remain-stable-2026.
[4] S. Kelly, “FDA rescinds LDT final rule,” TechTarget, Inc., 19 September 2025. Available: https://www.medtechdive.com/news/FDA-rescinds-LDT-final-rule/760645/.
[5] CMS, “HCPCS Quarterly Update,” 23 September 2025. Available: https://www.cms.gov/medicare/coding-billing/healthcare-common-procedure-system/quarterly-update.
[6] CMS, “Evaluation and Management Services,” September 2025. Available: https://www.cms.gov/files/document/mln006764-evaluation-management-services.pdf.
[7] E. Cerutti, M. Ashley, J. Emerson and E. Casolo, “What ‘federal funding cuts’ really mean for health systems,” Beckers Hospital Review, 29 September 2025. Available: https://www.beckershospitalreview.com/finance/what-federal-funding-cuts-really-mean-for-health-systems/.
[8] CMS, “ICD-10 Codes,” 1 October 2025. Available: https://www.cms.gov/medicare/coding-billing/icd-10-codes.
[9] J. Emerson, “Court orders Humana to pay $32M in fees following False Claims settlement,” Beckers Payer, 30 September 2025. Available: https://www.beckerspayer.com/legal/court-orders-humana-to-pay-32m-in-fees-following-false-claims-case/.
[10] American Hospital Association, “AHA Supports Administration Facilitating Health Insurer Pledge to Reform Prior Authorization,” 29 September 2025. Available: https://www.aha.org/lettercomment/2025-09-29-aha-supports-administration-facilitating-health-insurer-pledge-reform-prior-authorization.
[11] G. Bruce, “Epic unveils new interoperability features: 7 things to know,” Beckers Hospital Review, 25 September 2025. Available: https://www.beckershospitalreview.com/healthcare-information-technology/ehrs/epic-unveils-new-interoperability-features-7-things-to-know/.
