How to Stay Ahead of Quarterly and Annual Medicare Updates

The thing about quarterly and annual Medicare updates is that they’re always evolving—and fast! Medicare changes both quarterly and annually, and staying on top of these changes can make or break your billing processes. Let’s dive into the details, so you can keep your workflows up-to-date and avoid nasty surprises.

Key Takeaways

Medicare updates happen quarterly and annually, covering CPT codes, fee schedules, and reimbursements.
Quarterly updates focus on minor changes, while annual updates introduce larger, impactful adjustments.
CPT code compliance and accurate fee schedules are critical to avoid claim denials and revenue loss.
Telehealth billing policies continue to evolve post-COVID—keep an eye on new developments.
Commercial insurers often follow Medicare updates, impacting all types of practices.
Tools like CMS newsletters, coding software, and workflow management systems can simplify updates.

Quarterly Medicare Updates: Why They Matter

Most people think of Medicare changes as annual events, like the big updates that kick in every January 1st. But did you know Medicare also releases updates every quarter? These changes aren’t always as headline-grabbing as the yearly updates, but they can still have a big impact.

For example, Medicare may add or remove CPT codes, adjust fee schedules, or even change the definitions of CPT codes. A good example is when they removed CPT code 99201, a basic new patient evaluation, a few years ago. That update wasn’t just a quick switch—it required everyone, from physicians’ offices to large insurance companies, to adjust their policies and workflows ahead of time.

And here’s the catch: These quarterly updates can be tricky to keep up with. The best advice? Subscribe to the CMS newsletter. Trust me, those email updates are a lifesaver—quick, easy, and delivered right to your inbox.

Annual Medicare Updates: The Big Changes You Need to Plan For

While the quarterly updates are important, the major adjustments happen during the annual Medicare changes. Each July, Medicare releases a proposal for the updates it plans to implement for the following calendar year. These proposals include everything from CPT code changes to updates in RVUs (Relative Value Units) and reimbursement schedules.

For example, in 2023, Medicare proposed a $1.50 reduction in reimbursement per unit for the physician fee schedule. If you’re billing Medicare frequently, that might not seem like much, but it adds up quickly across hundreds or thousands of claims.

By November, these proposals are finalized, giving everyone (doctors, insurance companies, billing specialists—you name it) time to adjust before January 1st rolls around. Being proactive about these changes is critical. Once the new year hits, you must update your policies and fee schedules to avoid denials or costly mistakes.

How Medicare Changes Affect Telehealth Services

In addition to changes in CPT codes and reimbursements, Telehealth services have been a major focus of Medicare updates—especially since the Public Health Emergency (PHE) was declared.

During the PHE, telehealth expanded dramatically, and Medicare is working on solutions to preserve some of those benefits even after it ended. Keep an eye on this area because changes here could impact how you bill for Telehealth services, which are rapidly becoming a staple in many practices.

Why Staying on Top of Medicare Updates Matters (Even if You Don’t Bill Medicare)

Here’s a pro tip that most people don’t think about: Medicare changes don’t just affect Medicare. Many commercial insurance providers adopt Medicare’s rules and policies immediately or shortly after. So, even if you don’t see many Medicare patients, staying informed is crucial. The ripple effects can hit your practice, often when you least expect it.

Quick Tips to Stay Informed

Life gets busy. Emails pile up. And let’s be honest, Medicare updates aren’t exactly a thrilling read. That’s why setting a calendar reminder to check for updates quarterly—or skimming those CMS newsletters—can save you a ton of stress. Here’s the deal: If you don’t have someone dedicated to tracking Medicare changes, you’re asking for trouble.

Trust me, taking a few minutes every quarter to read these updates is much easier than dealing with denied claims or unexpected billing adjustments.

Quarterly and Annual Medicare Updates: Diving Into Specifics

Now that we’ve covered the overall framework of quarterly and annual Medicare updates let’s roll up our sleeves and dig deeper into specific examples and tips. This part will help you connect the dots between abstract policy changes and real-world billing scenarios. If you handle Medicare billing, this is where it gets juicy.

What Happens When Medicare Changes CPT Codes?

One of the most significant changes Medicare makes, quarterly and annually, is the addition, removal, or redefinition of CPT (Current Procedural Terminology) codes. These updates are crucial because they directly impact what services you can bill for and how much reimbursement you’ll receive.

Take the infamous removal of CPT code 99201 as an example. This was a basic new patient evaluation code used by many providers that Medicare decided to eliminate altogether. When they axed it, providers had to remove it from their fee schedules and billing systems to avoid accidental use. If they didn’t, claims were denied, money was left on the table, and it caused a billing nightmare.

Another example is 81000, a urinalysis code that saw updates in its definition. When Medicare changes definitions like this, it can alter not only how the service is coded but also how it’s reimbursed. That’s why reading CMS proposals early (and updating your internal systems) is an absolute must.

Understanding the Medicare Fee Schedule Changes

Medicare also updates its fee schedules regularly. These changes dictate how much reimbursement you’ll receive for specific services, which can directly affect your bottom line.

In the 2023 Medicare Physician Fee Schedule, for example, reimbursement was reduced by $1.50 per unit. Doesn’t sound like much, right? But let’s say you’re billing 1,000 units a month. That’s a $1,500 revenue hit—just from one small adjustment.

How to stay on top of this? Review the annual RVUs (Relative Value Units) and reimbursement rates for your most commonly used CPT codes. If reimbursement rates drop, you might need to adjust your financial forecasts or reevaluate how you schedule certain procedures.

Here’s a quick breakdown of what’s in the annual fee schedule update:

Category	What Changes?	When It Happens
CPT Code Values	RVUs, reimbursement rates	January 1st (annually)
Fee Schedules	Updates to service payments	January 1st (annually)
Drug Schedules	Adjustments for medication reimbursements	Throughout the year

Telehealth: Medicare’s Evolving Policy

Another critical area to monitor is Telehealth services. The Public Health Emergency (PHE) brought a wave of temporary expansions to Telehealth coverage, but these changes are starting to shift as we transition out of the emergency phase.

For instance, during the PHE, Medicare allowed for a broader range of services to be billed as Telehealth. This included things like routine check-ups and even mental health services. But what happens when the PHE ends? Medicare is working on policies to create a smoother transition, but you should prepare for potential changes. Some services might no longer qualify for Telehealth reimbursement, or stricter rules may apply.

To stay ahead:

Bookmark the CMS Telehealth Policy page.
Monitor any quarterly updates that mention Telehealth CPT codes.
Have someone in your office track this specifically—it’s worth it!

How CMS Proposals Affect You: A Timeline Example

To show you how Medicare’s annual proposal and update process works, let’s walk through a recent example:

July 2022: CMS released its proposed updates for the 2023 calendar year. These included changes to reimbursement rates, CPT code updates, and modifications to telehealth services.
November 2022: Final decisions on these proposals were announced. This gave providers about 60 days to prepare for implementation.
January 2023: The changes went into effect. By this time, practices needed to update their systems, train staff, and adjust workflows.

If you missed any part of this process—especially the early proposal phase—you’d be scrambling to adapt once the changes were finalized. That’s why I can’t stress enough: Get on those CMS email lists and set reminders for quarterly checks!

Quarterly Updates: Quick and Quiet Changes

Quarterly Medicare updates don’t have the same buzz as the annual changes, but they can still trip you up. For example, these updates often include:

Revised CPT definitions
New CPT codes
Changes to the drug fee schedule

Let’s say you’re billing a medication under a certain code and Medicare lowers its reimbursement rate without much fanfare. If you’re not watching closely, you might bill at the old rate and miss out on the new, reduced payment schedule.

Solution: Assign someone in your office (or yourself) to check for quarterly changes in:

CPT codes (additions/removals/updates)
Fee schedules (especially for high-volume procedures)
Definitions for anything you bill frequently

Commercial Insurers Follow Medicare’s Lead

Here’s where things get tricky: Even if you don’t bill Medicare, these changes still matter. Why? Because commercial insurers tend to follow Medicare’s lead.

For example, when Medicare removed CPT 99201, many private payers quickly did the same. If you didn’t update your billing systems, you might still use codes that private insurers no longer cover. This is why even non-Medicare providers must stay tuned to Medicare changes—they often set the standard for the entire healthcare industry.

Specific Tools to Help You Stay on Top of Quarterly and Annual Medicare Updates

Managing quarterly and annual Medicare updates can feel like juggling a dozen tasks while blindfolded. But thankfully, some tools can make the process smoother and less chaotic. Whether you’re a solo provider, part of a small practice, or managing billing for a large healthcare organization, these tools can help you track changes, adapt workflows, and avoid costly errors.

1. CMS Newsletters and Email Updates

The Centers for Medicare & Medicaid Services (CMS) is the best and most reliable source for Medicare updates. They provide email newsletters that directly deliver all relevant changes to your inbox. The updates are concise and often include links to deeper resources if you need more details.

How to Sign Up: Visit the CMS website and subscribe to their email updates. Make sure you’re signed up for categories like fee schedule updates, CPT code changes, and Telehealth policies.

Pro Tip: Set up an email folder or tagging system to organize these newsletters. That way, when quarterly updates roll in, you can find them quickly without sifting through a cluttered inbox.

2. Coding Software

Using a coding software tool is practically non-negotiable if you’re in charge of billing. These platforms are designed to automatically keep your coding compliant with the latest Medicare updates. Some of the best options include:

AAPC Coder is ideal for healthcare professionals who want an all-in-one coding tool. It provides updates on CPT, ICD-10, and HCPCS codes and explanations for the changes.
SuperCoder: This tool helps with coding and offers an intuitive search feature, so you can look up Medicare policies or reimbursement guidelines in seconds.
Optum360 EncoderPro: A favorite among larger organizations, this software integrates directly into your billing systems and automatically reflects quarterly and annual updates.

These tools do come with a price tag, but the time and headaches they save you will more than makeup for it.

3. Medicare Fee Schedule Look-Up Tool

When it comes to checking reimbursement rates or staying on top of changes to the Medicare Physician Fee Schedule, CMS’s own Fee Schedule Look-Up Tool is invaluable. This free, web-based tool lets you search for the reimbursement rates tied to specific CPT codes.

How to Use It: Enter the year, location, and the CPT code to find the exact payment amount Medicare will reimburse.
Why It’s Helpful: If you’re noticing discrepancies in your reimbursement rates, this tool can help you pinpoint why.

You can access the tool here.

4. Professional Association Resources

Joining a professional organization, such as the AAPC (American Academy of Professional Coders) or AHIMA (American Health Information Management Association), is another way to stay ahead of Medicare updates. These groups provide:

Webinars on Medicare updates
Coding workshops
Policy trackers
Community forums where members share insights and tips

These organizations are also great for networking, which is especially helpful when interpreting complex changes in Medicare policies.

5. Calendar Reminders and Workflow Management Tools

Sometimes the simplest tools are the most effective. Setting quarterly reminders in your calendar to check for Medicare updates is a straightforward way to ensure you’re never caught off guard. Pair this with a workflow management tool like Asana, Trello, or ClickUp, and you’ll have a system for reviewing, implementing, and communicating Medicare updates with your team.

Example Workflow:

Step 1: Set a recurring task (e.g., “Review CMS updates”) for the first week of every quarter.
Step 2: Assign someone to review the updates and summarize the key points.
Step 3: Share a brief update with your billing staff to ensure compliance.

6. Telehealth-Specific Tracking Tools

If you provide Telehealth services, you need a tool that tracks both Medicare and state-level Telehealth regulations. CAQH ProView is one example of a platform that helps providers stay compliant with shifting Telehealth policies.

Additionally, Telehealth Resource Centers (TRCs) provide free guidance and tools specific to your region. Visit the National Consortium of Telehealth Resource Centers to connect with your local TRC.

FAQs About Quarterly and Annual Medicare Updates

Staying on top of quarterly and annual Medicare updates can feel like drinking from a firehose—there’s a ton of information that constantly changes. Here’s a handy FAQ to answer the most common questions about Medicare updates and how they impact billing, coding, and reimbursement.

What’s the difference between quarterly and annual Medicare updates?

Quarterly Medicare updates are smaller, incremental changes that CMS releases every three months. These updates may include tweaks to CPT codes, small changes to the drug fee schedule, or minor clarifications to reimbursement policies.

Annual updates, on the other hand, are more comprehensive. They involve major changes like new RVUs (Relative Value Units), Medicare Physician Fee Schedule adjustments, or larger policy shifts (e.g., new Telehealth rules or CPT code removals). Annual updates take effect every January 1st.

How do I find out about upcoming Medicare changes?

The CMS website is your best friend for staying informed. Here’s where you should look:

CMS Newsroom: Regularly updated with press releases and announcements.
Medicare Learning Network (MLN): Offers free resources like newsletters and webinars to explain updates.
CMS Quarterly and Annual Proposals: These are released every July (for annual updates) and intermittently for quarterly updates.

To make things easier, subscribe to CMS newsletters to get updates straight to your inbox.

What happens if I don’t update my CPT codes or fee schedules?

If you don’t stay current with quarterly and annual Medicare updates, your practice risks:

Claim Denials: Using outdated CPT codes can lead to rejected claims.
Lost Revenue: You might bill for services at the wrong rate, leaving money on the table.
Compliance Issues: Not following updated Medicare policies can result in audits or penalties.

To avoid this, update your billing software and workflows whenever changes are announced.

Do these updates only apply to Medicare patients?

Not at all! Commercial insurance providers often adopt Medicare’s updates immediately or after a short delay. This means that these changes can still affect your billing and reimbursement processes even if you don’t see many Medicare patients.

For example, when Medicare removed CPT 99201, most commercial insurers followed suit shortly after. Staying on top of Medicare updates is essential, no matter who your primary payers are.

How can I track these updates more efficiently?

Here are some tools and strategies to help you track Medicare updates without losing your mind:

CMS Newsletters and Alerts: Subscribe for email updates.
Coding Software: Tools like AAPC Coder, SuperCoder, or Optum360 automatically update your CPT codes and reimbursement rates.
Fee Schedule Look-Up Tool: Use CMS’s free tool to check reimbursement rates for specific CPT codes.
Professional Associations: Groups like the AAPC or AHIMA provide webinars and workshops to help you stay informed.

How much time do I have to prepare for annual updates?

CMS releases annual Medicare proposals every July. These proposals give you an early look at what changes are coming the following January. The finalized updates are typically announced by November, giving you about 60 days to prepare.

Use this time to:

Update your fee schedules.
Train your staff on new or retired CPT codes.
Adjust your billing systems for new reimbursement policies.

How can I prepare my practice for quarterly updates?

Quarterly updates may not seem as dramatic, but they can still throw off your workflows if you’re not prepared. Here’s what to do:

Set a Reminder: Add a quarterly task to your calendar to check CMS updates.
Dedicate a Team Member: Assign someone in your office to monitor updates or subscribe to a coding service that tracks changes for you.
Review Key Resources: Focus on updates to CPT codes, drug schedules, and fee schedules.

Even small changes, like updates to CPT code definitions, can have a ripple effect on your billing.

What happens if Medicare reimbursement rates drop?

If Medicare lowers reimbursement rates for a specific service (as they did with the 2023 $1.50 per unit decrease), you’ll need to adjust your financial planning. Lower rates can:

Impact your revenue projections.
Force you to reevaluate how often you perform certain services.
Push you to negotiate higher rates with commercial payers.

Review your most frequently billed services and see how rate changes affect your bottom line.

Can I delegate tracking Medicare updates?

Absolutely! If you don’t have time to track Medicare updates yourself, you can:

Hire a third-party billing service to manage updates and compliance.
Assign a dedicated staff member to handle Medicare research.
Invest in coding and billing software that automatically updates for you.

Delegating this task ensures you stay compliant without adding extra stress.

Wrapping It All Up

Keeping track of quarterly and annual Medicare updates can feel overwhelming, but you can turn chaos into control with the right tools and strategies. From subscribing to CMS newsletters, using cutting-edge coding software, leveraging professional resources, and setting simple calendar reminders, you’ll always stay ahead of the curve.

Remember, these updates don’t just affect Medicare patients—commercial insurers often follow Medicare’s lead, so staying informed protects your entire revenue cycle.

And don’t forget: if all else fails, delegate! Having someone in your office (or a third-party billing company) dedicated to tracking Medicare updates can save time, money, and headaches.

Stay informed, stay compliant, and make Medicare updates work for you—not against you!