Developments with MOON, PEPPER, and Payment Reductions for Out-of-Network Care

Published: Mon, 12/22/25

Updated: Mon, 12/22/25

Link to all things medical coding & billing

Developments with MOON, PEPPER, and Payment Reductions for Out-of-Network Care

Let me start with the two big news items. First, Nina Youngstrom, the editor of the Report on Medicare Compliance, actually got a response from CMS about the Medicare Outpatient Observation Notice (MOON). As you know, the current form expired Nov. 30, and the new version has not been released. She was told that the new MOON should be released early in 2026.

Even More Misinformation on Incident-To Billing

A few months ago, I wrote about an article that asserted you can’t bill “incident to” when the patient has a new problem. In that article, I explained why the regulation makes it perfectly clear that all the Medicare Administrative Contractors (MACs) are wrong when they claim one can’t diagnose when billing “incident to.”

Comparing AAPC and AHIMA Certifications: Which Path Should You Take?

Have you ever caught yourself wondering if you should pursue an AAPC or AHIMA certification—and, more importantly, which one is the right fit? I've talked with so many aspiring coders who hit a wall at this very decision. There's plenty of noise out there, but below, I'll cut straight to what matters most so you can stop second-guessing and start preparing...

The New MOON, Leaving Against Medical Advice, and Sepsis

Lots of things happening last week for me to talk about. First, still no sign of the 2026 OPPS Final Rule. Many of us expected a Friday 5 p.m. release, but it did not happen. I wasn’t sure if I should have been sad or relieved. But the wait goes on. I also heard back from the CMS about the soon-to-expire Medicare Outpatient Observation Notice (MOON)...

The Removal of SDoH from the 2026 Final Rule

The 2026 Medicare Physician Schedule Final Rule includes several distinct policy changes in which the Centers for Medicare & Medicaid Services (CMS) modifies how it uses or pays for services related to social-risk drivers and the social determinants of health (SDoH), by either eliminating these terms altogether or reframing them under different...

AI is coming for the most boring job in healthcare

Neal K. Shah argues that a growing systemic failure to recover revenue in clinics is because growing claim denials are being treated as paperwork instead of actionable data. He says that artificial intelligence can help.

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