Compliance Monitor (06/30/2025)
Your source for federal updates
June-July 2025 Compliance Activity
| FY 2026 Proposed Hospice Payment Update Rule June 10, 2025 | Comments for the FY 2026 Proposed Hospice Payment Update Rule are due June 10, 2025. Instructions for submitting comments appear in the beginning of the rule. |
| CMS Proposed Home Health Payment Update Rule (NPRM) Expected posting in late June – early July | Annual CY issuance May include proposed regulatory information not included in the FY hospice payment update proposed rule Subscribe to the Federal Register for emails of newly posted regulations. The selection of content can be customized. Link to subscribe is listed on the following webpage: https://www.federalregister.gov/documents/current Will first appear on the Federal Register Public Inspection Desk https://www.federalregister.gov/pu blic-inspection/current Will move over to the Federal Register within 7 days of initial posting https://www.federalregister.gov/do cuments/current |
| Transition to All-Payer OASIS Data Collection and Submission July 1, 2025 | Collect and submit OASIS data for all patients with any pay source who are not exempt from OASIS data collection and who begin receiving home health care services with an OASIS SOC M0090 date on or after July 1, 2025 https://www.cms.gov/files/document/oasisall-payer-transition-fact-sheetdec-2024.pdf |
| 1557 compliance date correction July 5, 2025 | Covered entities are required to distribute a new notice to inform individuals of the availability of non-English assistance. The new notice replaces the old foreign language “taglines” that were required under previous versions of the Section 1557 regulations. Some employers have already redesigned their notices to meet this requirement when they met earlier Section 1557 notice deadlines in the fall. |
| CMS Proposed Home Health Payment Update Rule (NPRM) Annual CY issuance May include proposed regulatory information not included in the FY hospice payment update proposed rule. Subscribe to the Federal Register for emails of newly posted regulations. The selection of content can be customized. Link to subscribe is listed on the following webpage: https://www.federalregister.gov/documents/current | Usually posted in late June – early July Will first appear on the Federal Register Public Inspection Desk https://www.federalregister.gov/pu blic-inspection/current Will move over to the Federal Register within 7 days of initial posting https://www.federalregister.gov/do cuments/current |
Top Items
CMS Posts Memo – Release of CMS-2567: Statement of Deficiencies and Plan of Correction
CMS posted Memo, Release of CMS-2567: Statement of Deficiencies and Plan of Correction (QSO-25-19-All) on June 18, 2025. The memo updates practice allowing the release of the CMS-2567 immediately upon receipt by the provider, supplier, or lab. While they are updating the timeline for the public release of the CMS-2567, they are not changing the provider/supplier’s review window. Providers and suppliers will continue to have time to review and respond to the survey findings through the POC or AOC process. In accordance with Admin Info-24-14-All, the POC/AOC is releasable upon approval by CMS. If CMS is unable to approve a POC/AOC and instead conducts a revisit survey, there will not be a POC/AOC to release.
Alert: Medicare Fraud Scheme Involving Phishing Fax Requests
CMS has identified a fraud scheme targeting Medicare providers and suppliers. Scammers are impersonating CMS and sending phishing fax requests for medical records and documentation, falsely claiming to be part of a Medicare audit.
Important: CMS doesn’t initiate audits by requesting medical records via fax. Protect your information. If you receive a suspicious request, don’t respond. If you think you got a fraudulent or questionable request, work with your Medical Review Contractor to confirm if it’s real.
HHS Secretary Kennedy, CMS Administrator Oz Secure Industry Pledge to Fix Broken Prior Authorization System
WASHINGTON, DC—JUNE 23, 2025—U.S. Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. and Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz today met with industry leaders to discuss their pledge to streamline and improve the prior authorization processes for Medicare Advantage, Medicaid Managed Care, Health Insurance Marketplace® and commercial plans covering nearly eight out of 10 Americans.
In a roundtable discussion hosted by HHS, health insurers pledged six key reforms aimed at cutting red tape, accelerating care decisions, and enhancing transparency for patients and providers. Their commitments reinforce the role of CMS in monitoring outcomes and promoting accountability. Companies represented at the roundtable included Aetna, Inc., AHIP, Blue Cross Blue Shield Association, CareFirst BlueCross BlueShield, Centene Corporation, The Cigna Group, Elevance Health, GuideWell, Highmark Health, Humana, Inc., Kaiser Permanente, and UnitedHealthcare.
June 2025 Report to the Congress: Medicare and the Health Care Delivery System
As part of its mandate from the Congress, each June the Commission reports on improvements to Medicare payment systems and issues affecting the Medicare program, including changes to health care delivery and the market for health care services. Chapter 3 examines home health care use among Medicare Advantage enrollees. Using a combined dataset of the encounter and home health assessment data, the Commission assesses the use of home health care by MA enrollees.
Hospice/Palliative Care Provider Updates
Hospice Vendor Update and Errata (V1.00.2) for HOPE Data Specs (FINAL) Effective October 1, 2025
CMS announces the availability of a Hospice Vendor Update slide deck and an Errata (V1.00.2) for HOPE Data Specs (FINAL) Effective October 1, 2025. This information is available in the Downloads section of the HOPE Technical Information webpage and will help hospice vendors to prepare for HOPE Implementation.
Fall 2024 TEP Report Released
The Centers for Medicare & Medicaid Services (CMS) has released the Hospice Quality Reporting Program Fall 2024 Technical Expert Panel (TEP) Report. The document can be accessed from the Downloads section on the CMS HQRP Provider and Stakeholder Engagement page.
User Manual Update
The Hospice Quality Reporting Program (HQRP) Quality Measure (QM) Specifications User’s Manual V1.03 including HOPE Measures is now available. This QM Manual contains instructions to calculate all HQRP measures, including the HOPE-based quality measures. The document can be accessed from the Downloads section on the CMS HQRP Current Measures | CMS
DME Provider Updates
Commodes, Bed Pans & Urinals: Prevent Claim Denials
In 2023, the improper payment rate for commodes, bed pans, and urinals was 47.7%, with a projected improper payment amount of $4.4 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF)). Learn how to bill correctly for these services. Review the Commodes, Bed Pans & Urinals provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Documentation requirements
DMEPOS Fee Schedule: July 2025 Quarterly Update
Learn about updates (PDF) effective July 1, 2025:
- No added or deleted codes
- Corrections to the 2025 fee schedule amounts for certain items provided in non-contiguous areas
- Rural ZIP codes
All Providers Updates
This notice acknowledges the Secretary of the Department of Health and Human Services’ (the Secretary’s) receipt and review of Battelle Memorial Institute’s, the consensus based entity (CBE) under a contract with the Secretary, 2024 Annual Activities Report to Congress, as mandated by section 1890(b)(5) of the Social Security Act (the Act). The Secretary has reviewed CBE’s 2024 Annual Report and is publishing the report in the Federal Register together with the Secretary’s comments on the report not later than 6 months after receiving the report in accordance with section 1890(b)(5)(B) of the Act.
Semiannual Report to Congress – October 1, 2024-March 31, 2025
As described in this semiannual report, OIG’s total monetary impact during the reporting period was $16.61 billion, including $3.51 billion in investigative receivables, $451 million in audit receivables, and $12.65 billion in potential cost savings. OIG consistently delivers a strong return on investment (ROI) through its oversight and enforcement. OIG’s ROI is $11:$1 (a 3-year rolling average of expected recoveries and receivables from OIG work). Our enforcement efforts resulted in 744 civil and criminal actions during this reporting period, including settlements resulting from the use of OIG’s Civil Monetary Penalties Law authority and criminal convictions. Additionally, we identified and excluded 1,503 bad actors from participation in federally funded health care programs, ensuring that untrustworthy actors will not receive Federal health care program payments.
The OIG released a video highlighting the Medicaid Fraud Control Units’ (MFCUs’) annual report for Fiscal Year 2024. They also posted four enforcement actions. Watch a new video on MFCUs’ key role in fighting health care fraud, waste, and abuse. In Fiscal Year 2024, 53 MFCUs recovered $3.46 for every $1 spent—totaling $1.4 billion in recoveries.
Watch the video to learn more about their impact.
Educational Opportunities
Webinar on Empowering Patients to Change Behavior Using Digital Healthcare Tools
AHRQ will host a webinar on July 17th, 2025, from 12:30 – 2:00 p.m. ET that covers how empowering patients to take an active role in their health is key to driving meaningful and sustainable behavior change. By using tools like clinical decision support systems, artificial intelligence (AI)-powered platforms, and mobile health apps, healthcare providers can engage patients in managing chronic conditions and making informed decisions about their health. Our expert panel will discuss the critical role digital healthcare technologies play in driving healthier lifestyles and improving patient outcomes.
CE/CME accreditation of this activity is pending; if approved, eligible providers can earn up to 1.5 contact hours for participating in the live webinar.
CMS 2025 CMS Quality Conference
Virtual registration remains open for the 2025 CMS Quality Conference, where we unite on July 1–2 under the powerful theme: “Make America Healthy: Improving Health Outcomes Through Prevention, Quality, and Safety.”
We’ve built an agenda just for you, packed with insights, innovation, and inspiration:
- Live keynote sessions, including a fireside chat with CMS Administrator Dr. Mehmet Oz and a panel discussion with CMS Center Directors on Driving Disruption to Transform Care
- Five dynamic tracks covering quality, prevention, innovation, transplantation, and healthy aging
- Thought-provoking breakout sessions and virtual networking
CMS Resources
Resources to Improve Quality of Care
Check out CMS’s new Quality in Focus interactive video series. The series of 10–15 minute videos are tailored to provider types and aim to reduce the deficiencies most commonly cited during the CMS survey process, like infection control and accident prevention. Reducing these common deficiencies increases the quality of care for people with Medicare and Medicaid. Learn to:
• Understand surveyor evaluation criteria
• Recognize deficiencies
• Incorporate solutions into your facility’s standards of care See the Quality, Safety, & Education Portal Training Catalog, and select Quality in Focus