July 2025 Newsletter Highlights
A Note From Natalie
Let’s celebrate freedom, accuracy, and forward momentum — all July long.
This month, we celebrate not only the nation’s independence on July 4th, but also the continued strength and resilience of the Revenue Cycle Management industry. July is the perfect time to assess performance, update coding practices, and prepare for policy changes ahead. Looking for ways to level up your revenue cycle and improve coding compliance as well?
Remember: QualCode can help.
Natalie Williams ~ President & CEO
2025 budget reconciliation could be catastrophic for hospitals
The specifics: Experts say the substantial increase in uninsured Americans caused by Medicaid cuts would likely lead to more uncompensated care, putting an additional strain on hospital finances. Not surprisingly, rural hospitals would likely be hit the hardest because many already have negative margins.
What’s next: Track the status of the budget reconciliation bill here. This bill passed in the House on May 22, 2025 and goes to the Senate next for consideration.
Now is the time to focus on denial management and accurate medical coding to offset potential revenue loss.
Experts speculate on the impact of more aggressive Medicare Advantage audits
The specifics: In its FY 2026 budget request to Congress, CMS said it plans to increase its team of medical coders from 40 to approximately 2,000 by September 1, 2025. The goal? To address an ongoing backlog of Risk Adjustment Data Validation (RADV) audits to confirm that diagnoses used for payment are supported by medical records. The agency currently audits about 60 plans each year but intends to expand that to all 500-plus MA plans moving forward.
What’s next: Revenue cycle leaders should prepare for a potential impact of a more aggressive approach to MA audits that could include increased administrative burden and scrutiny over documentation, heightened risk of payment recoupments and denials, and stricter prior authorization and utilization management.
QualCode can help your organization prepare for what may lie ahead.
New ICD-10-CM and ICD-10-PCS codes
take effect October 1, 2025
The specifics: CMS recently announced its October 1, 2025, ICD-10-PCS procedure code update. The CDC did the same for its ICD-10-CM diagnosis code update effective the same date.
What’s next: Review these changes with medical coding staff to ensure coding compliance and revenue integrity.
Remember: QualCode can help you improve clinical documentation to meet any new requirements. In addition, it’s beneficial to look ahead to ICD-11. Experts say it’s important to understand some of the main areas and concepts that the new coding system includes.