Knowledge Base - Recent Articles
10/13/2025
Medicare Transmittals & MLN Articles
August 27, 2025: MLN MM14098: Implementing the Transforming Episode Accountability Model: Skilled Nursing Facility 3-Day Rule Waiver
Make sure your billing staff knows about updates the details, participation, and payments for the new Transforming Episode Accountability Model (TEAM) running from January 1, 2026 – December 31, 2030. For example, CMS will allow acute care hospitals who participate in the model to discharge patients without a 3-day hospital stay to a qualified SNF or swing bed provider, including a CAH. https://www.cms.gov/files/document/mm14098-implementing-transforming-episode-accountability-model-skilled-nursing-facility-3-day-rule.pdf
September 2, 2025: MLN MM14195: National Fee Schedule for Vaccine Administration: October 2025 Update
Make sure your billing staff knows about coding updates for: AVTOZMA® for post-exposure prophylaxis or COVID-19 treatment, and newly FDA-approved products not yet assigned to a unique HCPCS Level II code. https://www.cms.gov/files/document/mm14195-national-fee-schedule-vaccine-administration-october-2025-update.pdf
September 18, 2025: MLN Matters MM14136: Medicare Severity Diagnosis-Related Groups Subject to Inpatient Prospective Payment System Replaced Devices Policy: FY 2026 Update
Key Updates for FY 2026 related to this policy includes the addition of 2 MS-DRGs to the list subject to the policy for reducing payment for replaced devices offered without cost or with credit (MS-DRGs 209 and 213), and conforming title changes for 2 MS-DRGs (MS-DRGs 023 and 024). https://www.cms.gov/files/document/mm14136-medicare-severity-diagnosis-related-groups-subject-inpatient-prospective-payment-system.pdf
September 19, 2925: MLN MM14190: Hospice Payments: FY 2026 Update
CMS advises that you make sure your billing staff knows about FY 2026 hospice updates effective October 1, 2025, including payment rates, inpatient and aggregate caps, and wage index. https://www.cms.gov/files/document/mm14190-hospice-payments-fy-2026-update.pdf
September 22, 2025: MLN MM14203: Inpatient and Long-Term Care Hospital Prospective Payment Systems: FY 2026 Changes
CMS advises that you make sure your billing staff knows about the FY 2026 updates in this article.
This article should also be shared with HIM, CDI, Case Management, and Quality professionals. Examples of key updates included in this MLN article:
- CMS has deleted 6 MS-DRGs and finalized 5 new MS-DRGs, decreasing the number of MS-DRGs by 1 for a total of 772 for FY 2026.
- No MS-DRGs were added to or removed from the list of those subject to the post-acute transfer or special payment policies. Table 5 of the final rule includes a list of all post-acute and special post-acute MS-DRGs.
- Related to the new technology add-on payment policy for FY 2026, MAC implementation file 8 provides information on new technologies either continuing to receive payments, or those starting to receive payments, and technologies no longer eligible for the new technology add-on payment.
- This MLN article also includes updates related to quality programs (i.e., the Hospital-Acquired Condition Reduction Program, Value-Based Purchasing Program, and Hospital Readmission Reduction Program). https://www.cms.gov/files/document/mm14203-inpatient-long-term-care-hospital-prospective-payment-systems-fy-2026-changes.pdf
Coverage Updates
September 10, 2025: Screening for Colorectal Cancer-Non-Invasive Biomarker Tests National Coverage Analysis (NCA) (CAG-0040R)
CMS received a formal request to provide coverage for ColoSense, an FDA-approved multi-target stool RNA (mt-sRNA) colorectal cancer (CRC) screening test. This NCA focuses on coverage of CRC non-invasive biomarker screening tests, including mt-sRNA tests only and does not intend to review the long-standing coverage for fecal occult blood tests (FOBT). CMS is accepting comments until October 10, 2025. https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=319
September: CMS National Coverage Determination (NCD) Dashboard
At the time of the CMS NCD Dashboard September update, there are three open NCDs, five NCDs have been finalized in the past twelve months, there is one pending Transitional Coverage for Emerging Technologies (TCET) pathway topic and nine accepted requests on the NCD wait list. https://www.cms.gov/files/document/ncddashboard2025.pdf
Compliance Education Updates
July 2025: MLN Fact Sheet: MLN905364: Complying with Medicare Signature Requirements
CMS updated this fact sheet in July by adding information about stamped signatures, artificial intelligence, and attestations and signature logs. https://www.cms.gov/files/document/mln905364-complying-medicare-signature-requirements.pdf
September 2025: MLN Booklet: MLN006764: Evaluation and Management Services
CMS has made changes to several sections of this document including adding information regarding office or outpatient (O/O) Evaluation and Management (E/M) visits, critical care services, hospital outpatient clinic visits, and telehealth services.
Specific to telehealth services, if Congress takes no action prior to October 1, 2025, the statutory limitations that were in place for Medicare telehealth services before the COVID-19 public health emergency (PHE) will retake effect for most telehealth services. https://www.cms.gov/files/document/mln006764-evaluation-management-services.pdf
September 2025: Palmetto GBA Targeted Probe and Educate Checklist
Palmetto GBA, the Medicare Administrative Contractor (MAC) for Jurisdictions J and M published this checklist “to assist providers in all rounds of TPE to provide a better understanding of the Additional Documentation Request (ADR) process.” https://palmettogba.com/jja/did/4jklzyhi3t#ls
Other Updates
September 3, 2025: New Prior Authorization Demonstration for ASCs
CMS announced a new prior authorization demonstration for ASCs set to begin with discharges on or after December 15, 2025. Like the Prior authorization for Certain Hospital Outpatient (OPD) Services that began July 1, 2020, services targeted include:
- Blepharoplasty,
- Botulinum toxin injections,
- Panniculectomy,
- Rhinoplasty, and
- Vein ablation.
This demonstration will last for five years for ASCs in California, Florida, Texas, Arizona, Tennessee, Pennsylvania, Maryland, Georgia, and New York. You can read more about this demonstration on the CMS website at https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/prior-authorization-and-pre-claim-review-initiatives/prior-authorization-demonstration-certain-ambulatory-surgical-center-asc-services.
September 5, 2025: CMS Memorandum QS)-25-24-Hospitals: Updates to the State Operations Manual (SOM) Appendix A – New Interpretive Guidelines and Survey Processes reflecting Discharge Planning Conditions of Participation (COP)
Over five years later, CMS finally published sub-regulatory guidance related to the Discharge Planning Conditions of Participation (CoP) released in 2019 and 2020.
For example, in Appendix A §483.43(a) Standard: Discharge Planning Process, the interpretive guidelines indicate “the discharge planning process is expected to begin in the early stages in the hospitalization of the patient…However, no noncompliance deficiency citations will be made if the identification of patients likely to need discharge planning is completed at least 48 hours in advance of the patient’s discharge and there is no evidence that:
- The patient’s discharge was delayed due to the hospital’s failure to complete an appropriate discharge planning evaluation on a timely basis, or
- The patient was placed unnecessarily in a setting other than that from which he/she was admitted primarily due to a delay in discharge planning. For example, a delay in identification of a patient in need of discharge planning might result in discharging the patient to a nursing facility, because such placements can be arranged comparatively quickly, when the patient preferred to return home, and could have been supported in the home environment with arrangement of appropriate community services.”
In addition to interpretive guidelines for the Discharge Planning CoPs, there are also updates incorporating prior memorandums involving life safety code updates, co-location, electronic reporting for deaths in restraint and seclusion, infection prevention and control, Quality Assessment and Performance Improvement (QAPI), and ligature risk and assessments. I recommend sharing this Memorandum with key stakeholders within your facility. https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information/policy-memos/policy-memos-states-and-cms-locations/revisions-hospital-appendix-state-operations-manual
Beth Cobb
9/3/2025
Medicare Transmittals & MLN Articles
July 23, 2025: MLN MM14153: Laboratory National Coverage Determination Edit Software Updates: October 2025
Make sure your billing staff is aware of the ICD-10-CM codes that have been added to the National Coverage Determinations (NCDs). https://www.cms.gov/files/document/mm14153-laboratory-national-coverage-determination-edit-software-updates-october-2025.pdf
July 24, 2025: MLN MM14159: Acute Kidney Injury Renal Dialysis Billing: Additional Revenue Codes
Affected providers for this article includes ESRD facilities and other providers billing MACs for renal dialysis services. CMS advises that you make sure your billing staff is aware of changes to home dialysis billing for patients with acute kidney injury (AKI) starting January 1, 2025.
July 31, 2025: MLN MM14130: Billing the Laboratory Specimen Collection Travel Allowance to the 10th of a Mile
Effective January 1, 2026 providers will be allowed to bill HCPCS code P9603 calculated to the 10th of a mile. This MLN article provides information on how to bill to the 10th of a mile properly and when to bill using a whole number of miles. https://www.cms.gov/files/document/mm14130-billing-laboratory-specimen-collection-travel-allowance-10th-mile.pdf
August 4, 2025: MLN MM14101: Ambulatory Surgical Center Payment System: July 2025 Update
Initially released on June 6, 2025, this article was updated on Augusth 4, 2025 to update the number of new HCPCS code and coding information in the drugs, biologicals, and radiopharmaceuticals section. https://www.cms.gov/files/document/mm14101-ambulatory-surgical-center-payment-system-july-2025-update.pdf
August 5, 2025: MLN MM14185: Bypassing Common Working File Edits on Inpatient Medicare Part B Ancillary 12X Claims: Effective Date Change
CMS advises you to make sure your billing staff knows about the updates to the effective date for the bypass of Common Working File editing on inpatient Medicare Part B ancillary 12X claims previously added to Change Request 13810. https://www.cms.gov/files/document/mm14185-bypassing-common-working-file-edits-inpatient-medicare-part-b-ancillary-12x-claims-effective.pdf
August 22, 2025: MLN MM14197: ICD-10 & Other Coding Revisions to National Coverage Determinations: January 2026 Update (1 of 2)
Make sure your billing staff knows about updates to NCDs with new or deleted ICD-10-CM diagnosis codes effective January 1, 2026.
August 25, 2025: MLN MM14177: Home-Based Noninvasive Positive Pressure Ventilation to Treat Chronic Respiratory Failure Due to Chronic Obstructive Pulmonary Disease
Make sure your billing staff knows about updates effective June 9, 2025, including updated Medicare coverage guidance for respiratory assistance devices (RADs) and home mechanical ventilators (HMVs). https://www.cms.gov/files/document/mm14177-home-based-noninvasive-positive-pressure-ventilation-treat-chronic-respiratory-failure-due.pdf
August 26, 2025: MLN MM14194: ICD-10 & Other Coding Revisions to National Coverage Determinations: January 2026 Update (2 of 2)
Make sure your billing staff knows about updates to NCDs with new or deleted ICD-10-CM diagnosis codes effective January 1, 2026. https://www.cms.gov/files/document/mm14194-icd-10-other-coding-revisions-national-coverage-determinations-january-2026-update-2-2.pdf
Coverage Updates
June 2, 2025: Final Decision Memo (CAG-00468N) and NCD 20.38: Transcatheter Edge-to Edge Repair for Tricuspid Valve Regurgitation (T-TEER)
CMS has posted the final NCD and decision memo. This procedure is covered when furnished according to an FDA market-authorized indication and patient, physician and CED study criteria are met.
- Patient Criteria: Despite optimal medical therapy (OMT), patients must have symptomatic TR with tricuspid valve repair being considered as appropriate by a heart team.
- CMS noted in the Decision Memo that “we are finalizing the coverage indications without specifying TR severity. We note the final NCD criteria are consistent with the current FDA-approved label and will continue to align with FDA labeling for symptomatic TR if indication language on severity is updated.”
- Physician Criteria: The patient (preoperatively and postoperatively) is under the care of a heart team, which includes, at minimum, a Cardiac Surgeon, Interventional Cardiologist, Cardiologist with training and experience in heart failure management, and an Interventional echocardiographer. Per the Decision Memo, all specialists must have experience in the care and treatment of tricuspid regurgitation.
- Coverage with Evidence Development (CED) Study Criteria: The T-TEER items and services are furnished in the context of a CMS-approved CED study. CMS-approved CED study protocols must: include only those patients who meet the patient and physician criteria, and the study includes all the criteria listed in the NCD.
https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=316
Note: CMS published related MLN Matters Article MM14200 on August 20, 2025 and advises that you make sure your billing staff knows about the NCD criteria, coverage with evidence development (CED) study criteria, and claims processing requirements. https://www.cms.gov/files/document/mm14200-national-coverage-determination-2038-transcatheter-edge-edge-repair-tricuspid-valve.pdf
August 1, 2025: MLN Matters MM14149: National Coverage Determination 20.37: Transcatheter Tricuspid Valve Replacement (TTVR)
The Final Decision Memo for TTVR (CAG-00467N) was issued on March 19, 2025. This related MLN article provides detail about the coverage with evidence development (CED) study criteria and claims processing requirements. They also note that MACs will not search for files for TTVR claims processed with dates of service from March 19, 2025 to January 5, 2026; however, they’ll adjust any claims you bring to their attention. https://www.cms.gov/files/document/mm14149-national-coverage-determination-2037-transcatheter-tricuspid-valve-replacement.pdf
Note: CMS published related MLN Matters Article MM14149 on August 1st and advises that you make sure your billing staff knows about the NCD criteria, coverage with evidence development (CED) study criteria, and claims processing requirements. https://www.cms.gov/files/document/mm14149-national-coverage-determination-2037-transcatheter-tricuspid-valve-replacement.pdf
Compliance Education Updates
June 2025: MLN Booklet: MLN909188: Chronic Care Services
CMS updated this booklet with information about Advanced Primary Care Management (APCM). https://www.cms.gov/files/document/chroniccaremanagement.pdf
July 2025: MLN Educational Tool: MLN006559: Medicare Preventive Services Updated
In the Thursday, August 14th edition of MLN Connects, CMS included information about information added to several sections of the Medicare Preventive Services tool including:
- Alcohol misuse screening and counseling,
- Counseling to prevent tobacco use,
- Depression screening,
- Hepatitis C screening,
- PrEP using antiretroviral therapy to prevent HIV infection, and
- FAQ: billing the office and outpatient evaluation and management visit complexity add-on HCPCS code G2211 with Medicare Part B preventive services.
Other Updates
July 14, 2025: Livanta Provider Bulletin #24: Short Stay Reviews returning to the MACs
Livanta sent a bulletin to let providers know their contract as the National Claims Review Contractor concludes on August 11, 2025 that included the following about the transition of short stay reviews (SSR):
- September 1, 2025: Medicare Administrative Contractors will assume responsibility for conducting SSR.
- Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIO) will continue to conduct Higher Weighted Diagnosis-Related Group (HWDRG) reviews.
CMS noted during their July 30, 2025, webinar Inpatient Hospital Short Stay Review Transition, the short stay review policy has not changed, this shift in who will be reviewing records is an administrative change.
What is changing is the timing of the audit. Livanta reviewed claims post-payment, and the MACs will review claims pre-payment as part of the Targeted Probe and Education (TPE) program.
You will find a list of Inpatient Hospital FAQs re: Short Stays on the CMS website at https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/medical-review-and-education/inpatient-hospital-reviews-faqs#FAQs-7/3/2025. As of August 1, 2025, the FAQs were last updated on July 3, 2025.
July 14, 2025: CMS Published CY 2026 Physician Fee Schedule Proposed Rule
CMS Fact Sheet: https://www.cms.gov/newsroom/press-releases/cms-proposes-physician-payment-rule-significantly-cut-spending-waste-enhance-quality-measures-and
July 15, 2025: CMS Publishes CY 2026 OPPS Proposed Rule
Like the 2020 Proposed Rule, CMS has proposed to eliminate the current IPO List (approximately 1,731 services), through a 3-year transition. For CY 2026 they have proposed to eliminate 285 mostly musculoskeletal-related services.
CMS notes “Given the significant number of services on the list and that we would establish new reimbursement rates for those services under the OPPS, we recognize that interested parties may need time to adjust to the removal of procedures from the list. Providers may need time to prepare to furnish newly removed procedures on an outpatient basis, update their billing systems, and gain experience with newly removed procedures eligible to be paid under either the IPPS or OPPS.
They go on to note that “there is already a set of C-APCs for musculoskeletal services for patients in the outpatient setting, which facilitates the removal of these types of services from the IPO list for CY 2026.” To further facilitate this process, CMS is proposing “to establish a 7 level Musculoskeletal Procedures APC series, which will allow for the assignment of musculoskeletal procedures removed from the IPO to an APC with an applicable range of estimated costs.”
July 2025: CMS.Gov/Fraud: Hospice Fast Facts
CMS noted in the July 24th edition of MLN Connects that they have posted a new Hospice Fast Facts document to inform the public about significant enhancements to address hospice fraud, including:
- What hospital fraud is,
- How CMS has enhanced oversight, and
- What CMS is doing to stop fraud.
https://www.cms.gov/files/document/cpi-hospice-fast-facts.pdf
July 31, 2025: CMS MLN Matters Special Edition Announcing Final Rules
FY 2026 IPPS and Long-Term Care Hospital PPS Final Rule (CMS-1833-F) Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fy-2026-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective-0
FY 2026 Inpatient Rehabilitation Facilities PPS Final Rule (CMS-1829-F) Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fy-2026-inpatient-rehabilitation-facilities-prospective-payment-system-final-rule-cms-1829-f
FY 2026 Medicare Inpatient Psychiatric Facility PPS and Quality Reporting Final Rule (CMS-1831-F) Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fy-2026-medicare-inpatient-psychiatric-facility-prospective-payment-system-ipf-pps-and-quality
FY 2026 Skilled Nursing Facility (SNF) PPS Final Rule (CMS-1827-F) Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fy-2026-skilled-nursing-facility-snf-prospective-payment-system-final-rule-cms-1827-f
FY 2026 Hospice Wage Index and Payment Rate Update and Hospital Quality Reporting Program Requirements Final Rule (CMS-1835-F) Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fy-2026-hospice-wage-index-and-payment-rate-update-and-hospice-quality-reporting-program
Beth Cobb
7/3/2025
Medicare Transmittals & MLN Articles
June 6, 2025: MLN MM14101: Ambulatory Surgical Center Payment System: July 2025 Update
This article provides payment system updates effective July 1, 2025 for your billing staff.
June 9, 2025: MLN MM14089: ESRD Prospective Payment System: July 2025 Update
Make sure your billing staff are aware of changes to the outlier services listed under the ESRD PPS starting July 1, 2025.
https://www.cms.gov/files/document/mm14089-esrd-prospective-payment-system-july-2025-update.pdf
June 9, 2025: MLN 14041: ICD-10 & Other Coding Revisions to National Coverage Determinations: October 2025 Update
Make sure your billing staff knows about new codes and recent coding changes effective October 1, 2025 for the following NCDs:
20.9.1 Ventricular Assist Devices (VADs)
110.24 CAR T-cell Therapy
190.11 Home prothrombin time/international normalized ratio for monitoring for anticoagulation management
210.41 Counseling to Prevent Tobacco Use
210.13 Screening for Hepatitis C virus (HCV) in adults
June 10, 2025: MLN MM14031: Updates to Colorectal Cancer Screening & Hepatitis B Vaccine Policies
Make sure your billing staff knows about coverage changes for colorectal cancer (CRC) screening tests, policy clarification that applies to complete CRC screening, and expanded coverage and changes to billing policies for the hepatitis B vaccine. https://www.cms.gov/files/document/mm14031-updates-colorectal-cancer-screening-hepatitis-b-vaccine-policies.pdf
June 24, 2025: MLN Matters MM14132: Inpatient Rehabilitation Facility Prospective Payment System: FY 2026 Pricer Update
Per CMS actions needed that are listed in this MLN article includes FY 2026 IRF PPS rates, the rural transition policy, and the wage index cap. https://www.cms.gov/files/document/mm14132-inpatient-rehabilitation-facility-prospective-payment-system-fy-2026-pricer-update.pdf
June 30, 2025: MLN MM14091: Hospital Outpatient Prospective Payment System: July 2025 Update
This article highlights coding and billing changes effective July 1, 2025. For example, guidance is provided on how to bill for the split dose administration of AUCATZYL® (HCPCS code Q2058). https://www.cms.gov/files/document/mm14091-hospital-outpatient-prospective-payment-system-july-2025-update.pdf
Coverage Updates
June 9, 2025: Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to COPD Final National Coverage Determination
CMS posted this final NCD and decision memo establishing national Medicare coverage of respiratory assist devices and home mechanical ventilators. https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=315
Compliance Education Updates
April 2025: MLN Booklet: MLN1986542: Medicare & Mental Health Coverage
CMS made several revisions to this MLN booklet, for example they added information on provider caregiver training, depression screening, and tobacco use cessation counseling services through telehealth, and information about adding coverage information for opioid treatment programs, including Brixadi® and Opvee®. https://www.cms.gov/files/document/mln1986542-medicare-mental-health-coverage.pdf
May 2025: MLN Booklet: MLN9560465: Substance Use Screenings & Treatment
CMS made four changes to this MLN booklet, for example CMS has added safety planning intervention for patients in crisis and post-discharge phone follow-up contacts intervention. https://www.cms.gov/files/document/mln9560465-substance-use-screenings-treatment.pdf
May 2025: MLN Booklet: Screening, Brief Intervention & Referral to Treatment (SBIRT) Services
CMS made several changes to this MLN Booklet (MLN904084). For example, is the reminder that “you can prescribe controlled medications like buprenorphine using telehealth through December 31, 2025.” https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/sbirt_factsheet_icn904084.pdf
Other Updates
June 2, 2025: OIG Spring 2025 Semi-annual Report to Congress
In this report, the OIG has summarized their activities and accomplishments from October 1, 2024, through March 31, 2025. The OIG noted work during this period led to $16.61 billion total monetary impact, demonstrating the agency’s role in protecting taxpayer funds and improving program performance. https://oig.hhs.gov/documents/sar/10324/Spring_2025_SAR_508.pdf
June 5, 2025: MA Compliance Audit Results of Specific Diagnosis Codes
OIG completed this audit to examine diagnosis codes submitted by Coventry Health and Life Insurance Company. The OIG has identified the following 10 high-risk groups that include diagnoses at higher risk for being miscoded:
Acute stroke,
Acute myocardial infarction,
Embolism,
Sepsis,
Pressure Ulcer,
Lung cancer,
Breast cancer,
Colon cancer,
Prostate cancer, and
Ovarian Cancer.
Ultimately, OIG made three recommendations to Coventry, refund the Federal Government the $6.9 million in estimated net overpayments, identified similar instances of noncompliance after the audit period and refund any resulting overpayments, and continue to examine their existing compliance procedures to identify areas for improving compliance with Federal requirements. Coventry disagreed with some of the OIG findings and three of their recommendations. https://oig.hhs.gov/documents/audit/10329/A-02-22-01020.pdf
June 10, 2025: 2026 ICD-10-CM & PCS Files
CMS announced the October 1, 2025 procedure code and diagnosis code update files are now available. These codes are to be used for discharges occurring from October 1, 2025 to September 30, 2026, and for patient encounters for the same period.
The ICD-10-PCS Official Guidelines for Coding and Reporting for 2026 are available. As of June 26, 2025, CMS has not released the ICD-10-CM 2026 guidelines. https://www.cms.gov/medicare/coding-billing/icd-10-codes
June 23, 2025: Save the Date: July 30, 2025 CMS Teleconference on Transition of Short-Stay Reviews to the MACs
Effective September 1, 2025, MACs will assume responsibility for conducting short stay inpatient hospital medical reviews to determine appropriateness of the inpatient admission. This “save the date” announcement is to let providers know they will be holding a session on Wednesday, July 30, 2025 from 2-3PM ET to provide an overview about the transition of short stay reviews from the BFCC-QIOs to the MACs and address questions from beneficiary and industry stakeholders.
Prior to this session, you can find information about this transition on the CMS Inpatient Hospital Reviews webpage at https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/medical-review-and-education/hospital-patient-status-reviews.
June 26, 2025: Medicare Fraud Alert: Phishing Fax Requests
CMS noted in the Thursday, June 26, 2025 edition of the MLN Connects Newsletter that they have “identified a fraud scheme targeting Medicare providers and suppliers. Scammers are impersonating CMS and sending phishing fax requests for medical records and documentation, falsely claiming to be part of a Medicare audit.
Important: CMS doesn’t initiate audits by requesting medical records via fax. Protect your information. If you receive a suspicious request, don’t respond. If you think you got a fraudulent or questionable request, work with your Medical Review Contractor to confirm if it’s real.” https://www.cms.gov/training-education/medicare-learning-network/newsletter/2025-06-26-mlnc
Beth Cobb
No Results Found in Recent Articles!
Yes! Help me improve my Medicare FFS business.
Please, no soliciting.
We are an environmentally conscious company, dedicated to living “green” both at work and as individuals.
© Copyright 2020 Medical Management Plus, Inc.