Centers for Medicare & Medicaid Services has opened the review period for Program Year 2025 Open Payments data, giving covered recipients an opportunity to verify submitted information before it becomes public in June. Reporting entities submitted data between February 1 and March 31, and providers are now encouraged to review records for accuracy.
While participation is voluntary, reviewing this data is critical to ensuring that any reported financial relationships are accurate and properly represented. The Open Payments database is widely used by patients, researchers, and the media, making accuracy essential for maintaining transparency and avoiding potential misinterpretation.
Providers have the option to confirm or dispute any discrepancies, but disputes must be initiated by May 15, 2026, to be reflected in the upcoming public release. Registration in the Open Payments system is required to participate in the review and dispute process.
This review window is a key step in validating reported data before it is published and made accessible through CMS’s public search tools.
Clinical Diagnostic Laboratories: Get Ready to Report Starting Next Week HETS Action Required: Enroll Third-Party Vendors for Access by May 11 Vaccine Coding for Institutional Claims: Reporting Condition Code A6 Medicare Preventive Services – Revised
CMS Updates: Key Deadlines, Reporting Changes, and Preventive Service Revisions
Centers for Medicare & Medicaid Services has released several important updates impacting reporting requirements, system access, and billing practices—many with near-term deadlines.
Clinical Diagnostic Laboratories – Reporting Begins Soon
Clinical diagnostic laboratories should prepare to begin required data reporting as early as next week. Ensuring systems and documentation are in place will be critical for timely and accurate submission.
HETS Enrollment Deadline – May 11
Organizations using the HIPAA Eligibility Transaction System (HETS) must enroll any third-party vendors by May 11 to maintain uninterrupted access. This step is essential for eligibility verification workflows and avoiding potential disruptions.
Vaccine Coding Update – Condition Code A6
CMS is reinforcing guidance for institutional claims billing, requiring the use of Condition Code A6 when reporting certain vaccine-related services. Proper coding will be necessary to ensure accurate reimbursement and compliance.
Medicare Preventive Services – Revisions Issued
Updates to Medicare preventive service guidelines have been released, which may impact coverage, billing, and documentation requirements. Staying current on these revisions will help ensure compliance and optimal reimbursement.
Resource: MLN Connects® Newsletter