While CMS (the Centers for Medicare & Medicaid Services) usually releases new rules in the afternoon, on July 10 they chose to release the 2025 Outpatient Prospective Payment System (OPPS) Proposed Rule before 9 a.m. At 984 pages, the rule contains the usual adjustments to payment rates for both hospital outpatient services and ambulatory surgery center care, along with more efforts to promote health care equity and improve maternal health.
From the utilization management side though, it is generally status quo. The rule makes no adjustments to the Two-Midnight Rule, adds only three seldom-used codes related to complex liver procedures to the inpatient-only list, removes no surgeries from the inpatient-only list, and add several surgeries to the ambulatory surgery center covered procedure list, most notably placement and removal of a leadless pacemaker.
As has been discussed on Monitor Mondays and Talk Ten Tuesdays, the Supreme Court overturn of Chevron Deference creates an environment where many of the policies followed by hospitals are potentially subject to challenge in the courts. Perhaps CMS felt it best to avoid any major changes for 2025 to maintain some degree of regulatory stability, at least for now.
I was recently reviewing the Work Plan for the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). Let me start
Today, I’ll be writing about three key areas under review by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG):
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Uncover critical guidance. HIM coding expert, Kay Piper, RHIA, CDIP, CCS, provides an interactive review on important information in each of the AHA’s 2025 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s third quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s second quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
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