Coding Resource Center
March 2025
On February 25, 2025, the White House issued an Executive Order to reinforce healthcare price transparency compliance for radiology and other specialties. The order directs the Departments of the Treasury, Labor and Health and Human Services (HHS) to implement and enforce healthcare price transparency policy. Specifically: In November 2019, healthcare price transparency was mandated by […]
February 2025
Lawmakers Introduce Bill Boosting Physician Pay from April through December 2025 On Friday, January 31, 2025, a bipartisan coalition of lawmakers reintroduced a bill aimed at counteracting and surpassing a recent pay reduction for physicians that took effect at the beginning of the year. The Medicare Patient Access and Practice Stabilization Act of 2025, effective […]
The Merit-based Incentive Payment System (MIPS) was established by the Centers for Medicare and Medicaid Services (CMS) through the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. As part of the Quality Payment Program (QPP) under MACRA, MIPS was intended to financially reward Medicare providers (who are reimbursed under Medicare Part B covered professional […]
The Centers for Medicare and Medicaid (CMS) issued a new frequently asked questions (FAQ) for calendar year (CY) 2025. The Medicare physician fee schedule (MPFS) proposed and final rules published annually are the means by which CMS makes the telehealth changes for the ensuing year. This document can be found on the CMS website under […]
January 2025
On December 21, 2024, the American Relief Act (H.R. 10545) was signed into law. Among the key provisions is the extension of certain Medicare telehealth policy flexibilities for an additional 90 days, now set to expire on March 31, 2025. This extension ensures that Medicare beneficiaries can continue accessing telehealth services without interruption, maintaining the […]
On January 6, 2025, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) issued a proposed rule to update the Health Insurance Portability and Accountability Act (HIPAA) Security Rule. This comes as an increasing number of large data breaches in healthcare are occurring, including the attack on UnitedHealth’s Change Healthcare […]
The numbers are in for 2024, and they reveal that healthcare fraud investigations represent over half of settlements and judgments for the Department of Justice (DOJ). In a press release dated January 15, 2025, the Office of Public Affairs details the monies recovered and reported the highest number of Qui Tam actions in history were […]
December 2024
The President signed a critical spending bill, the American Relief Act, 2025 (H.R. 10545) on December 21, 2024, averting a government shutdown but leaving significant gaps in healthcare provisions. The bill has drawn mixed reactions, particularly from the healthcare sector, as several key measures included in earlier bipartisan resolutions were ultimately excluded. Among the retained […]
The Centers for Medicare and Medicaid Services (CMS) announced it is implementing 50 new procedure codes into the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS), effective April 1, 2025. The Code Tables, Index and related Addenda files for the new 50 procedures are available on the CMS website under ICD-10. The International […]
A report issued by the Office of Inspector General (OIG) revealed providers did not always comply with Federal requirements when billing for surgical services, particularly co-surgery and assistant-at-surgery services. Under Medicare Part B, The Centers for Medicare and Medicaid Services (CMS) makes a reduction in payment for physicians who work together as co-surgeons during a […]
