H.R. 1 Impact on Coding
Timothy Powell, CPA, CHCP
December 15, 2025
H.R. 1 doesn’t directly rewrite ICD-10 or CPT, but it does change the environment in which you’re coding. The impact is mostly indirect – through
CMS IPPS for 2020 takes a giant step forward.
For those who somehow missed it, there are 88 current ICD-10-CM Z codes and subcategories that encompass psychosocial and socioeconomic circumstances: Z55-65. One of these codes is Z59: Problems related to housing and economic circumstances. These Z codes have been part of the healthcare landscape for several years now, so if you’re thinking “these aren’t new,” you are correct.
However, here’s what is new. I know many who have been going to bed with the Centers for Medicare & Medicaid Services (CMS) Inpatient Prospective Payment System (IPPS) 2020 Proposed Rule under their pillow, hoping osmosis would foster awareness of every key element. For those actively following reimbursement for the Social Determinants of Health (SDoH), however, page 300 holds the Holy Grail. On that page is an entry with vital fiscal considerations for every healthcare organization.
The ICD-10 code Z59.0, Homelessness, is being proposed in IPPS 2020 as a complication or comorbidity (CC). This coding for homelessness will be worth thousands of dollars, at a minimum, in additional reimbursement to organizations for Medicare patients. As shared by my esteemed colleague, Dr. Ronald Hirsch, in his Monday Rounds last month, “now that CMS has taken the first two steps, they still need to learn to walk by recognizing that many more social determinants influence the cost of care, and establishing them as (CCs) or a major complication or comorbidity (MCCs).” Truer words were never said.
The Costs of Homelessness
Especially for my case management, coding, and physician advisor colleagues, you know exactly to what I’m referring. These are the patients who cost your organizations millions of dollars annually to manage. Patients with higher home instability risk are especially vulnerable; these persons experience risk of eviction or foreclosure, along with not being able to afford necessary utilities. They are 32 percent more likely to exceed the average length of hospitalization. According to the U.S. Department of Housing and Urban Development Point in Time Survey, 549,928 people are homeless in the U.S. on any given night, with 32 percent in unsheltered locations. Over 77,000 are chronically homeless. In California alone, homeless patients made about 100,000 visits to hospitals in a year, a 28 percent rise over the previous years. Lacking basic resources and support systems, these patients are five times more likely to be hospitalized in an inpatient unit, and stay on average four days longer in-house than other patients with the same diagnoses; that’s a cost of $2,000 to $4,000 per day.
Since Jan. 1 of this year, 12 hospitals and health systems have filed for bankruptsy. The causes include challenges with reimbursement and decreasing patient numbers: so much for the whole value versus volume focus. On the other hand, many entities have joined forces to directly address their population shifts and social determinants needs. In the first quarter of 2019 there were 27 mergers of hospitals and health systems. These collaborations have united key services for populations, enhancing care opportunities for those at risk, as defined by the SDoH, and otherwise. Some of these partnerships have saved institutions from closure. The partnership of the Center for Housing and Health and the University of Illinois Hospital saw healthcare costs fall as much as 60 percent.
Impact for the Future
To be honest, if CMS were to allow all the subcategories in Z59 to be coded as CCs, it would be a powerful financial boost to hospitals.
The need to ensure appropriate coding and reimbursement for those codes has been a popular headline this spring. The 23 new ICD-10 Z Codes proposed by the American Medical Association (AMA) and UnitedHealthcare address among the costliest issues to negatively impact hospitals, health systems, and other organizations. Notice that housing is listed as a potential new code for further expansion for this listing, as well as:
Areas also in desperate need of attention are food insecurity and transportation. Food insecurity-related healthcare costs in the United States are measured at $160.7 billion annually. Roughly 40 million adults lived in food-insecure households in 2017, with almost another 10 million people challenged to afford basic nutrition. Transportation issues force over 3 million patients annually to cancel, skip, or reschedule appointments with providers; the costs are estimated at upwards of $150 billion annually in healthcare consequences for patients and lost revenue in missed appointment time for providers.
CMS Must Play Catch-up
CMS is already behind the curve, especially with a majority of managed care entities already reimbursing for and providing support to address housing, plus the full scope of SDoH. The healthcare industry can’t afford for CMS to fall even further behind by delaying approval of reimbursement for society’s most basic human needs. Hopefully, public comment and subsequent actions will yield the only logical response for the industry: allowing reimbursement by CMS for homelessness. Let this action serve as an important step for CMS to recognize the need for financial accountability and attention to the full spectrum of SDoH. Only then can hospitals, healthcare systems, and organizations achieve true financial sustainability for the future.
H.R. 1 doesn’t directly rewrite ICD-10 or CPT, but it does change the environment in which you’re coding. The impact is mostly indirect – through
In the CY 2026 Physician Fee Schedule (PFS) Final Rule, the Centers for Medicare & Medicaid Services (CMS) made significant changes to the applicable use
Please log in to your account to comment on this article.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
