Thursday, July 10, 2025
News
- Hospital Price Transparency: Respond to Accuracy & Completeness RFI by July 21
- Alert: Medicare Fraud Scheme Involving Phishing Requests Via Fax and Other Means
- Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation: Final National Coverage Determination
Compliance
- Medicare Improperly Paid Suppliers for Intermittent Urinary Catheters
- Acute Care Hospital Outpatient Services for Hospice Enrollees: Reduce Improper Payments
Claims, Pricers & Codes
From Our Federal Partners
News
Hospital Price Transparency: Respond to Accuracy & Completeness RFI by July 21
CMS issued a Request for Information (RFI) seeking public input on whether and how we can improve hospital price transparency (HPT) compliance and enforcement processes to ensure that the hospital pricing data in the machine-readable file is accurate and complete. This RFI relates to the President’s Executive Order 14221, to ensure compliance with the transparent reporting of complete, accurate, and meaningful HPT data.
More Information:
Respond by 11:59 pm ET on July 21, 2025.
Alert: Medicare Fraud Scheme Involving Phishing Requests Via Fax and Other Means
CMS has identified a fraud scheme targeting Medicare providers and suppliers. Scammers are impersonating CMS and sending phishing requests for medical records or payment of alleged Medicare debts, often via fax or email, falsely claiming to be part of a Medicare audit or debt collection efforts.
Important: CMS generally doesn’t initiate audits via fax or email unless a provider requests it, and Medicare overpayment collections are handled through an established process through the Medicare Administrative Contractors (MACs). 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 a medical records request is real or your MAC for overpayment collections.
Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation: Final National Coverage Determination
CMS released a final national coverage determination and decision memo for Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER).
Compliance
Medicare Improperly Paid Suppliers for Intermittent Urinary Catheters
In a report, the Office of the Inspector General found that Medicare improperly paid for catheters and kits. To avoid improper payments, review the Urological Supplies provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Refill and documentation requirements
Acute Care Hospital Outpatient Services for Hospice Enrollees: Reduce Improper Payments
In a report, the Office of the Inspector General found that Medicare improperly paid acute-care hospitals for outpatient services provided to hospice enrollees. To avoid improper payments, request and analyze hospice election statement addendums for these enrollees.
Review the Acute Care Hospital Inpatient Prospective Payment System educational tool for more information:
- We don’t pay for services given to palliate or manage a terminal illness and related conditions. Services should be provided under arrangements with the hospice provider.
- We only pay for Part B outpatient services that are unrelated to the terminal illness and related conditions.
Claims, Pricers & Codes
HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals
CMS published the 2025 HCPCS Application Summary for Quarter 2, 2025 Drugs and Biologicals. See HCPCS Level II Coding Decisions for more information.
From Our Federal Partners
Providers Accepting CHAMPVA: You Must Get Paid by EFT
If you treat patients who are covered by the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), you must sign up for direct deposit (electronic funds transfer (EFT)) to get paid. Getting paid by EFT isn’t optional, it’s a federal requirement. VA paused claims payments for providers who aren’t enrolled in EFT and will resume payments once they enroll.
Enrolling in EFT helps:
- Keep CHAMPVA claim payments secure, efficient, and compliant
- Protect Veterans’ family members’ access to benefits
2 steps to enroll in EFT:
- Visit the VA Financial Services Center Customer Engagement Portal
- Complete the Payment Account Setup webform; call Financial Services Center customer support at 877-353-9791 for help
About CHAMPVA
CHAMPVA is a health care program for qualified spouses, widows(ers), and children of eligible Veterans. Through CHAMPVA, VA shares the cost of certain health care services and supplies with eligible beneficiaries.
For more information, visit the CHAMPVA–Information for Providers webpage.
Subscribe to the MLN Connects® newsletter, or read past editions.
View the Medicare Learning Network® Content Disclaimer and Department of Health & Human Services Disclosure.
The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health & Human Services (HHS).
