Limits on prepay review among changes you'll see when Medicare reforms kick in Jan. 1

Why This Topic Matters

Medicare reform changes can affect whether claims are paid, delayed, or rejected, and they may require workflow updates across billing, compliance, and clinical reporting. Understanding the scope of these updates helps practices prepare for implementation deadlines and avoid disruptions.

Article Sections

1. Prepayment review limits and implementation timing

   Discusses Medicare guidance on when prepayment review may be limited after self-reported billing errors, along with timing for claim filing and carrier implementation. The section also contrasts prepayment and postpayment review at a high level.

2. Key billing and payment changes for the new year

   Summarizes several Medicare changes taking effect with the new year, including coding updates, payment adjustments, preventive screening coverage, hospice-related billing, deductible changes, and ESRD billing revisions.