2025 Telehealth Update
Flexibilities that will continue include:
Flexibilities that will expire include:
As part of the 2025 Medicare Fee Schedule (MPFS) Final Rule, effective January 1, 2025, the Centers for Medicare and Medicaid (CMS) finalized policies for telehealth; however, these policies do not fully align with the telehealth extension provisions outlined in H.R.10545. This is because the timeframe in which CMS prepares the proposed and final rules typically starts immediately after the previous year’s policies are finalized. Examples include:
H.R. 10545 provides a temporary solution but highlights the need for long-term legislative action to solidify telehealth’s role in the healthcare system. Organizations such as the Center for Connected Health Policy (CCHPA) hopes “CMS will soon provide some clarity/direction on the policies that may not be in full alignment with each other and where there remain discrepancies between CMS 2025 PFS actions and HR 10545. “
Bills That May Impact Imaging in 2025Physician Reimbursement
Radiologists have faced reimbursement reductions that have cumulated over the past two decades. Because Medicare reimbursements now struggle to cover the cost of a physician running their own practice, the result is an increase in the number of physicians that do not accept Medicare, which in turn increases patient wait times and access to care. The Center’s for Medicare and Medicaid Services (CMS) CY 2025 Final Rule included another 2.8% decrease in physician payments, effective January 1, 2025. However, there is a pending bill introduced in Congress by Republican Gregory Murphy. Bill H.R. 10073, the “Medicare Patient Access and Practice Stabilization Act of 2024,” is an attempt to counteract the 2.8% decrease in physician reimbursement. H.R. 10073 is a bipartisan bill which states its purpose is “To amend title XVIII of the Social Security Act to increase support for physicians and other practitioners in adjusting to Medicare payment changes.” If passed, H.R. 10073 will eliminate the 2.8% decrease and provide a 1.8% increase to physician reimbursement that is long overdue, particularly for radiologists.
Access to Preventative Breast Imaging
In continued efforts to aid early detection of breast cancer in women with dense breasts, bill H.R. 3086, the “Find it Early Act,” is also receiving bipartisan support in Congress. H.R. 3086 states its purpose is “To provide for health coverage with no cost-sharing for additional breast screenings for certain individuals at greater risk for breast cancer.” It is now understood that women with dense breasts may be at increased risk for breast cancer. Since there is no distinguishing between cancer or breast density which both show up white on a mammogram, patients with dense breasts may require additional imaging beyond a screening. However, diagnostic mammograms or other advanced imaging modalities come at a higher out-of-pocket cost to the patients that need them. Financial barriers can create disparities among this patient population. If passed, H.R. 3086 would require insurance companies to cover additional imaging exams (e.g. ultrasound or MRI screenings) for women that are considered high risk (e.g. dense breasts, BRCA carrier, family history of cancer, personal history of cancer, etc.) with no out-of-pocket cost.
American College of Radiology Listing
The American College of Radiology (ACR) has a page on their website for current legislative issues that may affect radiology, including their stance on the issues. While bills passed in Congress become Federal Law that apply to all 50 states, the ACR also highlights additional bills introduced in the Senate or House that may impact radiology on the state level.
HHS Proposes HIPAA Security Rule Update Amid Data Breaches
On January 6, 2025, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) issued a proposed rule to update the Health Insurance Portability and Accountability Act (HIPAA) Security Rule. This comes as an increasing number of large data breaches in healthcare are occurring, including the attack on UnitedHealth’s Change Healthcare in February 2024. The impacts this breach had on healthcare providers and patients demonstrated to officials the need to strengthen cybersecurity for protected health information. “These attacks endanger patients by exposing vulnerabilities in our health care system, degrading patient trust, disrupting patient care, diverting patients, and delaying medical procedures,” HHS Deputy Secretary Andrea Palm explained. This is the first time the HIPAA Security Rule has been updated since 2013.
This rule would provide specific instructions regarding what covered entities (healthcare providers, health plans and clearing houses) and their business associates (billing or coding companies, practice management services, IT vendors, medical device service providers, etc.) must do to secure electronic protected health information (ePHI). The ORC stated the updated policies would better align the HIPAA Security Rule with “modern best practices in cybersecurity”. Specifically, the proposed rule addresses:
The HHS encourages the public and stakeholders to submit comments on regulations.gov by searching for the Docket ID number HHS-OCR-0945-AA22 on or before March 7, 2025. The effective date of the final rule would be 60 days after publication.
Healthcare Settlements Total $1.67 Billion in 2024
The numbers are in for 2024, and they reveal that healthcare fraud investigations represent over half of settlements and judgments for the Department of Justice (DOJ). In a press release dated January 15, 2025, the Office of Public Affairs details the monies recovered and reported the highest number of Qui Tam actions in history were filed in fiscal year 2024. A Qui Tam whistleblower is typically an employee of the organization committing fraud; however, anyone with information about fraudulent healthcare activities can report under the False Claims Act (FCA) to assist the government in recovering monies resulting from fraud and abuse. The whistleblower can earn a reward if the lawsuit is successfully prosecuted. Principal Deputy Associate Attorney General Mizer stated, “The False Claims Act and its whistleblower provisions remain a critical tool in protecting the public fisc and ensuring that taxpayer funds serve the purposes for which they were intended.”
A Qui Tam lawsuit of particular interest within the 2024 healthcare settlements was originally filed by a whistleblower named Lynda Pinto, who was a former billing manager of Cardiac Imaging Inc. (CII). The complaint alleged that CII President and co-owner, Rick Nassenstein, participated in a scheme from 2017 thru 2023 involving payment of excessive fees to cardiologists who referred patients to CII for PET scans. CII provided mobile cardiac PET scans, which require physician supervision. The complaint further alleged that referring cardiologists were paid for supervising CII’s mobile cardiac PET scans, while they were either seeing other patients, or not even on-site when the scans were performed. The complaint led to an $85 million settlement with CII and its founder in Fiscal Year (FY) 2024. The head of the Justice Department’s Civil Division, Brian M. Boynton, stated “Financial relationships between healthcare providers and referring physicians can undermine the objectivity of medical treatment decisions and increase the cost of care. The Justice Department will enforce provisions designed to prevent prohibited financial conflicts to ensure that taxpayers and patients can have confidence that decisions about patient care are driven by the medical needs of patients rather than the financial interests of physicians or providers.” As coverage with Medicare Advantage plans continue to grow, the Department of Justice also noted ongoing litigation with United Health Group (UHG), Elevance Health and Kaiser Permanente, which involves reporting diagnosis codes that are not supported in the patient’s medical record. Reporting a condition that the patient does not have, or that is more severe than the patient’s actual condition can result in overpayments. The DOJ stated UHG “knowingly disregarded information about beneficiaries’ medical conditions and ignored information about invalid diagnoses from healthcare providers with financial incentives to furnish such diagnoses.” Also being investigated by the DOJ are Aetna, Bravo Health, Cigna, Health Net and Humana. Ensuring compliance with proper physician supervision, documentation, and medical billing and coding policies and procedures continues to be an area of importance in 2025. U.S. Device Guide Offered
Endovascular Today is a print and on-line publication which provides thorough coverage of the endovascular field, including the latest technology and techniques. As part of their coverage, the publication offers a U.S. Device Guide. The chart can be accessed by device category, and is organized alphabetically by manufacturer name, device size, configurations and unique characteristics. It is updated throughout the year and represents current listings.
All rights reserved. No part of this newsletter may be reproduced in any form whatsoever without written permission from the publisher. This newsletter may reflect coding information from the 2025 Physician’s Current Procedural Terminology (CPT® Manual). CPT is a registered trademark of the American Medical Association. CPT® five-digit codes, nomenclature and other data are copyright 2024 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT®. This product should not be considered a substitute for the codes, cross-references and exclusions located in the CPT® Manual. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for the data contained herein or not contained herein.
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