Healthcare Compliance

Medicare Transmittals and Updates

The Centers for Medicare & Medicaid Services (CMS) has issued several transmittals and updates for Medicare in late December 2023. These documents provide guidance on coding, payment systems, and policy clarifications for healthcare providers. Key updates include changes to ICD-10, IVIG items, ACO REACH model APIs, and the ASC payment system.

Medicare Transmittals: Policy Changes and Coverage Updates

The Centers for Medicare & Medicaid Services (CMS) has issued several transmittals in late 2024 detailing policy changes and coverage updates for Medicare. These updates affect various aspects of Medicare benefits, billing, and claims processing, with implementation dates extending into 2025.

Medicare Policy Updates and Coding Changes

The Centers for Medicare & Medicaid Services (CMS) has issued several transmittals detailing policy updates and coding changes for Medicare in 2026. These updates cover various areas including the Review Choice Demonstration, SSI/Medicare beneficiary data, preventive services, error rate testing, and specific payment systems. The implementation dates for these changes range from April to May 2026.

2025 Medicare Transmittals and Implementation Dates

The Centers for Medicare & Medicaid Services (CMS) has released its 2025 transmittals, detailing updates and implementation dates for various Medicare programs. These documents outline changes to payment systems, data reporting, and operational procedures for healthcare providers.

Hospital Billing Requirements Review for Overpayment Risk

The Centers for Medicare and Medicaid Services (CMS) announced a review series focused on hospital billing requirements to identify overpayment risks. A completed project for Sarasota Memorial Hospital identified at least $12.1 million in Medicare overpayments due to non-compliance with billing requirements.

HHS Agencies' Drug Control Funds Review Completed

The HHS Office of Inspector General has completed its mandatory review of HHS agencies' annual accounting of National Drug Control Program funds for fiscal year 2025. The review, which assessed compliance with ONDCP circular requirements, found no material modifications needed for the CDC and FDA reports.

Medicare Advantage Risk-Adjustment Data - Documentation Review

The HHS OIG announced a series of projects to review documentation supporting diagnosis codes submitted by Medicare Advantage organizations to CMS. CMS estimates 9.5% of payments to MA organizations are improper due to unsupported diagnoses.

Medicaid Applied Behavior Analysis Audits for Children with Autism

The HHS Office of Inspector General announced a series of audits of Medicaid Applied Behavior Analysis (ABA) services for children with autism. These audits aim to determine if state Medicaid agencies' payments complied with federal and state requirements, following identification of questionable billing patterns.

Kidney Transplant Patient Selection Criteria and Waitlist Outcomes Report

The HHS Office of Inspector General has completed a report on patient selection criteria for kidney transplants and waitlist outcomes. The report found that half of patients evaluated for a kidney transplant in 2023 were not added to the waitlist, with psychosocial criteria being a common reason for denial.

Joint Commission Launches Children's Health Strategy and Revises Standards

The Joint Commission has launched a new children's health strategy and is revising its accreditation and certification standards to better address the unique needs of pediatric patients. This initiative involves forming a Children's Healthcare Advisory Committee to guide the revisions.