June 2025 Newsletter Highlights
A Note From Natalie
In the Month of June, find creative ways to honor diversity of all kinds within your department.
This month, we celebrate LGBTQ Pride Month commemorating the contributions of lesbian, gay, bisexual, transgender, and queer individuals.
We also celebrate Juneteenth, short for June 19th, recognizing the ending of slavery in the United States.
Looking for ways to level up your revenue cycle and improve coding compliance?
Remember: QualCode can help.
Natalie Williams ~ President & CEO
Medicaid cuts would hurt struggling providers, experts say
The specifics: At least $715 billion in cuts to Medicaid could become a reality if health provisions in the budget resolution (termed ‘One Big, Beautiful Bill’) are finalized. At least 8.6 million Americans could lose coverage.
What’s next: Organizations must understand how Medicaid cuts could threaten financial stability and take steps now to mitigate financial impact. Partnering with an outsource vendor may be one way to lay the groundwork for nimble revenue cycle management processes.
Healthcare Price Transparency
The specifics: The departments of Labor, Health and Human Services, and the Treasury recently announced a Request for Information (RFI) seeking public input on how to improve prescription drug price transparency. The agencies also released updated guidance for health plans and health insurance issuers that sets a clear applicability date for publishing an enhanced technical format for disclosures. Finally, CMS released new guidance to strengthen the Hospital Price Transparency requirements, requiring hospitals to post the actual prices of items and services, not estimates. CMS also issued its own RFI to gather public feedback on how to boost hospital compliance.
What’s next: Review these documents, provide public feedback, and stay tuned for future developments.
CMS expands Medicare Advantage audits immediately
The specifics: Beginning immediately, CMS announced it will audit all eligible Medicare Advantage contracts in what the agency is calling an “aggressive strategy.”
What’s next: CMS will deploy advanced systems to review medical records and flag unsupported diagnoses. It will also increase its team of medical coders from 40 to approximately 2,000 by September 1, 2025, to manually verify flagged diagnoses to ensure accuracy. Finally, CMS will collaborate with the OIG to recover uncollected over-payments identified in past audits.