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Author: Lauren Brown

Senate Inquiry Focuses on AI Use in Medicare Advantage Prior Authorization

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Two U.S. senators are requesting information from UnitedHealthcare, Humana, and CVS Health regarding their use of artificial intelligence and other automated technologies in Medicare Advantage prior authorization and post-acute care coverage decisions. The inquiry follows recent federal oversight reports that examined denial rates and prior authorization practices among Medicare Advantage plans. Lawmakers are seeking details on how these insurers use AI, algorithms, or predictive technologies to support coverage determinations, as well as the safeguards in place to…
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CMS Updates: Additional Medicare Billing and Coverage Reminders

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CMS recently released several updates that may affect provider billing, compliance, and patient care. Highlights include: Resources: Optometry Services at Nursing Facilities: Bill Correctly Screening for Hepatitis C Virus in Adults National Coverage Determination: Using HCPCS Code G0567 HCPCS Codes Used for Home Health Consolidated Billing Enforcement: October 2026 Quarterly Update Hospice Claims: Reporting a Face-to-Face Encounter for Recertification Using Telecommunications Technology Domestically Acquired Cyclosporiasis Cases in Multiple U.S. States VA Payments: Enroll in Direct…
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CMS Releases New QPP Participation Data and 2027 QRDA III Reporting Resources

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CMS has announced two important updates for practices participating in the Quality Payment Program (QPP) and Alternative Payment Models (APMs). The Quality Payment Program Participation Status Tool has been updated with the first 2026 snapshot of APM participation data, based on Medicare Part B claims from January 1 through March 31, 2026. Eligible clinicians should log into the QPP Portal to verify their information and confirm their Qualifying APM Participant (QP) or MIPS APM participation status. Providers who qualify as QPs may…
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Hospital Consolidation Continues Across the Southeast

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Hospital acquisitions and partnerships continue across the Southeast as health systems respond to financial pressures, workforce shortages, and the need to preserve access to care. Here are seven notable developments affecting Alabama, Mississippi, and Tennessee: These ongoing transactions reflect the continued trend of regional health system expansion and may influence referral networks, service availability, and patient access throughout the Southeast. Resource: 27 academic health systems acquiring hospitals

CMS Proposes New Restrictions for Remote Patient Monitoring Services

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CMS has proposed several changes to Medicare payment rules for remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) as part of the 2027 Physician Fee Schedule. Here are six key takeaways: Practices that currently use outsourced RPM or RTM services should review the proposed rule and monitor future CMS updates to understand how these changes could affect their workflows and Medicare reimbursement. Resource: CMS proposes ban on third-party remote patient monitoring: 6 notes

CMS Releases Latest Medicare Diabetes Prevention Program Newsletter

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CMS has published the latest Medicare Diabetes Prevention Program (MDPP) Bulletin, featuring program announcements, policy updates, important reminders, and resources for organizations participating in or supporting the MDPP. The newsletter provides timely information to help providers stay informed about program requirements and best practices for helping Medicare beneficiaries prevent or delay the onset of Type 2 diabetes. Resource: NewsletterMedicare Diabetes Prevention Program (MDPP)

Cervical Cancer Screening with HPV Testing: Billing Reminder for Medicare Providers

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Medicare reminds providers that cervical cancer screening with high-risk HPV testing is covered as a preventive service for asymptomatic female patients ages 30–65 once every five years. To ensure proper reimbursement, laboratories and providers should bill HCPCS code G0476 when performing a covered high-risk HPV test in conjunction with a Pap test. Practices should review their current billing and coding processes to confirm the correct code is being used for eligible Medicare patients. CMS has also provided…
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CMS Launches Medicare GLP-1 Bridge to Expand Access to Weight Loss Medications

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CMS has introduced the Medicare GLP-1 Bridge, a new initiative that allows eligible Medicare Part D beneficiaries to access certain GLP-1 medications for $50 per month. The program is designed to improve affordability for qualifying individuals while evaluating how expanded access to these medications impacts health outcomes and the Medicare program. The initiative will run through December 31, 2027 and is intended for Medicare beneficiaries who meet specific eligibility requirements. Not everyone with Medicare will qualify, including individuals who…
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Jackson Hospital Faces Uncertain Future Amid Reimbursement Negotiations

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Jackson Hospital in Montgomery continues to face an uncertain future as negotiations with Blue Cross Blue Shield of Alabama over reimbursement rates remain ongoing. Hospital leadership has indicated that without a sustainable financial agreement, the organization may be forced to cease operations. The hospital’s board is expected to review the latest proposals before making a final decision. Hospital leaders have emphasized that reaching a reimbursement agreement would provide the opportunity to stabilize operations, restore services,…
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Jackson Hospital Investigating Network Security Incident

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Montgomery-based Jackson Hospital is investigating a recent network security incident after detecting suspicious activity within its computer systems on June 8. According to hospital officials, the organization immediately launched an investigation with the assistance of third-party cybersecurity and digital forensic specialists. At this time, the incident appears to be limited in scope, and the hospital has reported no evidence of data loss. Jackson Hospital also stated that patient care operations have not been affected and…
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Medicare Advantage by the Numbers: 10 Trends Shaping 2026

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A recent analysis from KFF highlights continued growth in Medicare Advantage (MA) enrollment, although expansion has slowed compared to previous years. The data also shows increasing participation in Special Needs Plans (SNPs) and shifting enrollment among major insurers. 1. More Than Half of Medicare Beneficiaries Choose Medicare Advantage Medicare Advantage now covers 55% of all eligible Medicare beneficiaries, a significant increase from 19% in 2007. 2. Enrollment Growth Continues, but at a Slower Pace Between…
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ADA Accessibility Standards for Medical Equipment: Key Compliance Deadlines Approaching

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Healthcare organizations should be aware of new accessibility requirements issued by the U.S. Department of Justice under the Americans with Disabilities Act (ADA). The rule establishes enforceable accessibility standards for medical diagnostic equipment (MDE), helping ensure patients with disabilities have equitable access to healthcare services. The requirements apply to state and local government healthcare entities and address equipment commonly used during patient care, including examination tables, weight scales, imaging equipment, and other diagnostic devices. The…
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