May 2025 Newsletter Highlights
A Note From Natalie
May is recognized as Mental Health Awareness Month.
The month of May also includes the celebration of National Nurses Week from May 6 - 12, 2025. We encourage you to take a moment to acknowledge and appreciate the hard-working nurses within your organization.
Looking for ways to level up your revenue cycle and improve coding compliance?
Remember: QualCode can help.
Natalie Williams ~ President & CEO
CMS finalizes an increase in average benchmark payments to MA plans
The specifics: CMS recently finalized an increase in the average benchmark payments to MA plans by 5.06%, or $25 billion.
What’s next: With these increased payments to payers comes the potential for better negotiated rates with providers, bonuses, and higher quality-based incentive payments. However, with higher payments from CMS, MA plans may expect more from providers in terms of clinical documentation, quality scores, and patient satisfaction.
CMS publishes the July 2025 NCD update.
The specifics: CMS recently published its most recent NCD update, effective July 1, 2025. NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.
What’s next: Review the NCD updates with coding and billing staff to ensure compliance and avoid denials.
Screening for SDOH in EDs needs improvement.
The specifics: Less than one-third of EDs screen for social determinants of health, such as food or housing insecurity, according to a new report. Among EDs with screening policies, 81.6% had response policies in place, primarily utilizing social work consultations, although only 20.5% had an ED-based social worker and 23.4% had around-the-clock social work availability.
What’s next: Authors say EDs must expand SDOH screening practices; however, organizations must also ensure EDs have the resources and infrastructure to respond appropriately to identified social needs.