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Author: Lauren Brown

Understanding PR 96 Denials: Common Causes and Prevention Strategies

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PR 96 denial codes indicate that a service is considered non-covered under a patient’s insurance plan, making the patient financially responsible for the charge. These denials can occur even on clean claims and often stem from coverage limitations, policy exclusions, or documentation issues. Common causes of PR 96 denials include: To help reduce PR 96 denials, providers are encouraged to strengthen insurance verification processes, obtain prior authorizations when required, improve coding accuracy, and educate both…
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Summer Travel Safety Tips for Heat and Sun Exposure

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With summer travel and outdoor activities increasing, healthcare professionals are encouraging individuals to take extra precautions to protect themselves from heat-related illness and sun exposure. Recommended safety measures include using water-resistant sunscreen with adequate SPF protection, reapplying after swimming or prolonged outdoor activity, and wearing hats and sunglasses to help reduce direct sun exposure and protect eye health. Hydration is also a major focus, particularly for individuals sensitive to heat or bright sunlight. Electrolyte drink…
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CMS Updates: Mental Health, RPM Compliance, ASM Participation & More

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National Mental Health Awareness Month Highlights Preventive Care Access During National Mental Health Awareness Month, Centers for Medicare & Medicaid Services is encouraging providers to prioritize mental health and preventive care services for Medicare patients. CMS emphasized that mental health plays a major role in healthy aging and overall quality of life, while also reminding providers that many Medicare preventive services are available to patients at no cost when assignment is accepted. CMS also highlighted several behavioral…
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CMS Releases Updated eCQM Specifications for 2027 Reporting Period

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Centers for Medicare & Medicaid Services has released updated electronic clinical quality measure (eCQM) specifications and implementation resources for the 2027 reporting and performance period across hospital inpatient, hospital outpatient, and eligible clinician quality reporting programs. The annual updates are designed to keep measures aligned with current clinical guidelines, coding standards, and healthcare reporting requirements. The updated resources include revised eCQM specifications, implementation guidance, technical release notes, telehealth guidance, and measure reference tables available through the…
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Physician Specialties See Strong Compensation Growth in 2026

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A new physician compensation report from Medscape shows several medical specialties experienced notable pay increases in 2026, signaling continued shifts in healthcare workforce demand and reimbursement trends. Cardiology led all specialties with a 10% increase in compensation, followed closely by ophthalmology and radiology at 9%. The report, based on survey responses from nearly 6,000 physicians across 29 specialties, found that most specialties saw at least modest salary growth compared to the previous year. Emergency medicine, anesthesiology, and…
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CDC Warns of Increased Tick Bite ER Visits Across the U.S.

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The Centers for Disease Control and Prevention (CDC) is reporting unusually high rates of emergency room visits related to tick bites across much of the country, with current activity reaching the highest levels seen for this time of year since 2017 in most U.S. regions. Ahead of Lyme Disease Awareness Month, the CDC is encouraging individuals and healthcare providers to remain vigilant as tick season intensifies. Ticks can transmit several serious illnesses, including Lyme disease, Rocky Mountain spotted fever,…
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Key Healthcare Developments Impacting Alabama Providers in 2026

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1. Rural Hospitals Receive Major Financial and Technology Support Alabama is moving forward with significant investments aimed at stabilizing struggling rural hospitals and modernizing healthcare infrastructure across the state. Recent updates to Alabama’s rural hospital donation tax-credit program, combined with more than $203 million in first-year federal funding through the Rural Health Transformation Program, are expected to support initiatives tied to EHR modernization, cybersecurity, EMS services, maternal health programs, and workforce development. State leaders have…
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Federal vs. State AI Rules: What Payers Need to Know

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As states continue introducing prior authorization reforms tied to artificial intelligence, payers are facing growing uncertainty around how AI can be used in claims reviews and medical necessity determinations. A recent KFF analysis outlines several key issues shaping the future of AI regulation in healthcare. As AI adoption expands across healthcare operations, providers and payers may need to monitor both state legislation and emerging federal guidance closely to remain compliant and prepared for future regulatory…
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CMS Launching $50 Monthly GLP-1 Medication Program for Medicare Beneficiaries

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Beginning July 1, 2026, CMS will introduce the Medicare GLP-1 Bridge demonstration program, allowing eligible Medicare Part D beneficiaries to access select GLP-1 medications for a capped cost of $50 per month through the end of 2027. The initiative is designed to improve affordability and access to GLP-1 therapies, which are increasingly used to support weight management and related chronic health conditions but often remain financially out of reach for many seniors. CMS says the…
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CY 2024 Doctors and Clinicians Preview Period Opens May 13

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CMS will open the CY 2024 Doctors and Clinicians Preview Period on May 13, 2026, giving providers an opportunity to review their Quality Payment Program (QPP) performance information before it becomes publicly available on Medicare.gov and the Provider Data Catalog. During the preview period, clinicians and groups can securely access and review their reported performance data through the QPP website to verify accuracy and prepare for upcoming public reporting. This early review period is an…
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2026 QPP Exception Applications Now Open

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The 2026 Quality Payment Program (QPP) exception applications are officially available through December 31, 2026, giving eligible clinicians, groups, virtual groups, and APM participants an opportunity to request relief from certain Merit-based Incentive Payment System (MIPS) reporting requirements when circumstances prevent successful participation. This year’s applications include two primary exception pathways: the Promoting Interoperability Hardship Exception and the Extreme and Uncontrollable Circumstances (EUC) Exception. These options are designed to support providers facing challenges such as…
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