October 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. 

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Lab Developed Test Final Rule Rescinded

The FDA rescinded the final rule on laboratory developed tests.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].