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HR 3580119th CongressIntroduced
Oversight of Medicare Billing Code Cost Act
Introduced: May 23, 2025
HealthcareSocial Services
Standard Summary
Comprehensive overview in 1-2 paragraphs
The Oversight of Medicare Billing Code Cost Act aims to increase transparency and oversight of how Medicare billing codes are added, changed, or removed. It requires the Department of Health and Human Services (HHS) Inspector General to conduct a comprehensive study of CMS processes for modifying billing codes under Medicare (title XVIII) and to deliver a report to Congress within 12 months with findings and recommendations for legislative or administrative actions to improve transparency and oversight. In addition, starting in 2025, the Secretary of Health and Human Services must annually publish a public report charting any new Medicare billing codes added in the prior year, including the associated usage volumes and expenditures.
Key Points
- 1HHS OIG must conduct a comprehensive study of CMS processes for adding, modifying, and removing Medicare billing codes (title XVIII), including:
- 2- Types of data and analyses CMS uses
- 3- Trends in the number and types of codes added, modified, removed, or revalued
- 4- Which medical areas or specialties are experiencing the most growth in codes
- 5- How CMS monitors effects on patient outcomes, costs over time, and other issues
- 6A report detailing the study’s findings and recommending legislative or administrative actions to improve transparency and oversight must be submitted to Congress within 12 months of enactment.
- 7Beginning in 2025, the Secretary of HHS must annually publish a report (and make it publicly available on CMS’s website) listing all billing codes added to Medicare during the preceding year, along with the associated volume and expenditures for those codes.
- 8The act emphasizes transparency and oversight of Medicare coding practices, with information to be shared with Congress and the public.
Impact Areas
Primary group/area affected- CMS and the HHS Office of Inspector General (OIG) are directly involved in conducting the study and implementing the annual reporting requirement.- Medicare providers and suppliers who use billing codes will be affected by greater transparency, as new codes and associated utilization data will be public.- Medicare beneficiaries could be affected indirectly through enhanced monitoring of how coding changes influence services, utilization, and costs.Secondary group/area affected- Congress and taxpayers who rely on transparent reporting of Medicare coding activities and spending.- Health policy researchers and watchdog groups who analyze Medicare coding trends and cost drivers.Additional impacts- Administrative burden on CMS and OIG to collect, analyze, and publish data on billing codes annually.- Potential influence on coding practices and policy decisions as more data becomes publicly available, which could affect provider behavior and coding strategies.- Improved ability to monitor the relationship between coding changes and outcomes or overall program costs over time.
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