2025-07-17-MLNC

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Date
2025-07-17
Title
Weekly Edition
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Thursday July 17, 2025

News

Compliance

Claims, Pricers & Codes

Publications & Multimedia

 

 

News

CMS Announces Resources, Flexibilities to Assist with Public Health Emergency in State of Texas

CMS announced resources and flexibilities to support individuals and health care providers affected by the severe storms, straight-line winds, and flooding in Texas.

Following a Major Disaster Declaration by President Donald J. Trump on July 6 and a Public Health Emergency declaration by HHS Secretary Robert F. Kennedy, Jr. on July 8, CMS is working with Texas and federal partners to ensure continued access to care.

Read the full news alert.

 

Skilled Nursing Facilities: Revalidation Deadline Extended to January 1

Enrolled skilled nursing facilities should collect data on ownership, managerial, and related party information and submit their revalidation. CMS extended the deadline to January 1, 2026. 

More Information:

 

Join an Accountable Care Organization

Medicare Providers: To participate in an Accountable Care Organization (ACO) for performance year 2026, work with an ACO to join their participant list. ACOs must submit their lists to CMS by August 1, 2025, by:

Participant taxpayer identification numbers cannot overlap multiple ACO participant lists. Resolve any overlaps by September 8. 

More Information:

 

Compliance

Ostomy Supplies: Prevent Claim Denials

In 2023, the improper payment rate for ostomy supplies was 25.6%, with a projected improper payment amount of $56.8 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF)). Learn how to bill correctly for these services. Review the Ostomy Supplies provider compliance tip for more information, including:

  • Billing codes
  • Denial reasons and how to prevent them
  • Refill and documentation requirements

 

Claims, Pricers & Codes

Core-Based Statistical Area: Revised ZIP Code Files

CMS identified a discrepancy in the rural indicators within the core-based statistical area ZIP Code files for January, April, and July of 2025, resulting in incorrect designations.

We issued revised files on June 25. Your Medicare Administrative Contractor will automatically reprocess all affected claims. You don’t need to take any action.

 

Publications & Multimedia

Chronic Care Management Services — Revised

CMS added information about advanced primary care management (PDF).

 

Patients in Custody Under a Penal Authority — Revised

Learn about changes effective January 1, 2025 (PDF):

  • Patients in custody no longer includes those on bail, on parole, on probation, on home detention, or who are required to live in halfway houses or other community-based transitional facilities
  • Expanded the eligibility criteria for the special enrollment period for formerly incarcerated individuals

 


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