2025 Significant changes for healthcare insurance billing
In 2025, several significant changes are being implemented in healthcare insurance billing, particularly concerning Medicare and related services. Key updates include:
Medicare Physician Fee Schedule (PFS) Adjustments:
Payment Reduction: The Centers for Medicare & Medicaid Services (CMS) has finalized a 2.83% decrease in the Medicare PFS conversion factor for Calendar Year (CY) 2025, lowering it from $33.29 to $32.35. This reduction is expected to impact physician reimbursement rates.
Caregiver Training Services: CMS is introducing new coding and payment structures for caregiver training services, including those provided via telehealth. These services encompass training in areas such as wound care and infection control.
Advanced Primary Care Management (APCM) Services: New coding and payment models are being established for APCM services, aiming to reduce administrative burdens by bundling elements of existing care management and communication technology-based services.
Medicare Advantage and Part D Updates:
Payment Increase: Payments to Medicare Advantage (MA) plans are projected to rise by an average of 3.7%, equating to over $16 billion, as per the CY 2025 Rate Announcement.
Prescription Drug Cost Cap: A significant revision in Medicare prescription-drug benefits is set for 2025, offering a lower out-of-pocket cost cap and options to spread medication expenses throughout the year. Enrollees must stay informed to fully benefit during the open-enrollment period from October 15 to December 7, 2024.
Hospital Outpatient Services:
Rate Update: CMS has finalized a 2.9% rate increase for hospital outpatient departments and ambulatory surgery centers, resulting in an additional $2.2 billion in funding for 2025. Despite this increase, hospital associations have expressed concerns that the update may not sufficiently address rising operational costs.
Potential Overhaul of Medicare Billing Codes:
Proposed Changes: Robert F. Kennedy Jr., appointed by President Donald Trump as the head of the U.S. Department of Health and Human Services, is considering significant changes to the Medicare billing system. Kennedy plans to remove the American Medical Association's (AMA) control over Medicare billing codes, a system that has been in place since the 1980s. This move could disrupt the existing Medicare billing process and threaten the AMA's primary revenue source, as the organization currently maintains these codes.
These developments reflect ongoing efforts to adjust healthcare insurance billing practices in response to economic factors and the evolving needs of patients and providers.
Sources:
https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2025-medicare-physician-fee-schedule-final-rule?utm_source
https://www.cms.gov/files/document/mm13887-medicare-physician-fee-schedule-final-rule-summary-cy-2025.pdf?utm_source
https://www.cms.gov/files/document/mm13887-medicare-physician-fee-schedule-final-rule-summary-cy-2025.pdf?utm_source
https://public3.pagefreezer.com/browse/HHS.gov/02-01-2025T05:49/https://www.hhs.gov/about/news/2024/04/01/cms-finalizes-payment-updates-2025-medicare-advantage-medicare-part-d-programs.html?utm_source
