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Author: Lauren Brown

Reminder: APP Plus Quality Data Submission Deadline Approaching for ACOs

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The data submission period for Performance Year (PY) 2025 under the Quality Payment Program (QPP) is currently open, with a deadline of March 31, 2026, at 8:00 p.m. ET. Organizations participating in the Medicare Shared Savings Program should review and submit their quality data before the deadline, as updates or corrections will not be accepted once the submission window closes. For PY 2025, Accountable Care Organizations (ACOs) are required to report quality data using the…
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CMS Finalizes HCPCS Level II B2 2025 Coding Updates

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The Centers for Medicare & Medicaid Services (CMS) has released the final determinations for the HCPCS Level II Second Biannual (B2) 2025 coding cycle covering non-drug and non-biological items and services. The update includes new codes, revisions to existing codes, and final decisions on submitted coding applications. These determinations help define how certain items and services are reported, categorized under Medicare benefits, and potentially reimbursed. The CMS publication also outlines each request reviewed during the…
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Flu Remains Major Seasonal Threat as COVID-19 Becomes More Predictable

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Recent reporting highlights that the United States has experienced two consecutive severe flu seasons, while the impact of COVID-19 has become more stable and predictable. Experts note that unlike seasonal influenza—which typically peaks in winter—COVID-19 continues to circulate year-round with occasional summer increases. Recent flu seasons have also been complicated by unusual influenza strains that reduced the effectiveness of annual vaccines, though widespread prior infection and vaccination have helped maintain strong protection against severe COVID…
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Insurers Increasing Scrutiny on E/M Billing Practices

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Modifier 25 Reimbursement ChangesBlue Cross Blue Shield of Michigan plans to reduce reimbursement by 50% for certain office visits billed with modifier 25 when a procedure is performed the same day, beginning May 1. The policy focuses on minor procedures and aims to prevent duplicate payment for evaluation services that may already be included in a procedure’s global period, though some services—such as emergency visits and procedures without a global period—are exempt. Automatic Downcoding PoliciesCigna…
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CDC Report Highlights Rise in KSHV Infections Among Organ Transplant Recipients

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A new report in the Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention highlights a sharp increase in infections linked to Kaposi Sarcoma–associated herpesvirus (KSHV) among U.S. solid organ transplant recipients between 2021 and 2025. During this period, 46 donors were suspected of transmitting the virus—up significantly from previous years—leading to infections in nearly half of the 153 recipients who received organs from those donors, including 25 deaths. Because transplant…
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Study Finds Medicare Add-On Code G2211 Increasing Physician Payments

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A study published in JAMA found that the Medicare add-on billing code G2211 generated about $394 million in payments in 2024, its first year of use, after being billed 26 million times for 10.6 million patients. Although the code was originally intended to support primary care providers managing ongoing or complex patient care, specialists accounted for a large share of usage due to Medicare rules preventing specialty-restricted billing codes. The findings highlight how the code—introduced…
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Medicare Extends No-Pay Summary Notice Mailing Timeline

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Centers for Medicare & Medicaid Services has updated the mailing schedule for No-Pay Medicare Summary Notice (MSN) statements, changing the frequency from every 120 days to every 180 days beginning Jan. 1, 2026. The update applies to notices sent when no claims payments are made during a period, and CMS is also encouraging beneficiaries to opt for digital MSNs to access their notices electronically instead of waiting for mailed statements. Resource: No-Pay Medicare Summary Notice…
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CDC Study Highlights Measles Spread Linked to Air Travel

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Researchers from the Centers for Disease Control and Prevention reported that an unvaccinated traveler who flew from Europe to the United States while infectious with Measles transmitted the virus to 17 additional people, including passengers exposed during flights, at the airport, and through subsequent community spread. The investigation traced 135 exposed travelers, with infections occurring on both international and domestic flights, and several cases requiring hospitalization. The findings highlight the importance of vaccination before international…
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Congress Restores 3.1% Medicare APM Bonus for Physicians

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A provision in the Consolidated Appropriations Act, 2026 restores a 3.1% incentive bonus for physicians participating in Medicare Alternative Payment Models (APMs) for the 2026 performance year. The bonus, which had expired in 2024, was reinstated through the bipartisan funding package passed by Congress and will be paid to eligible physicians in the 2028 payment year, consistent with the payment timeline established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Resource: 3.1%…
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CMS Transitions CLIA Program to Fully Paperless System

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Centers for Medicare & Medicaid Services has completed the transition to a fully paperless system for the Clinical Laboratory Improvement Amendments (CLIA) program. CLIA certificates and fee coupons will no longer be mailed, and all certification and survey fees must now be paid online rather than by paper check. Laboratories must also ensure they have a valid email address on file to receive electronic certificates, billing notices, and other CMS communications to avoid potential certification…
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UnitedHealthcare Introducing New Referral Requirements for Some Medicare Advantage Plans in 2026

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Beginning Jan. 1, 2026, UnitedHealthcare will require most members enrolled in Medicare Advantage HMO and HMO-POS plans to obtain a primary care provider (PCP) referral before seeing certain specialists in outpatient, office, or home settings. Referrals must be submitted to UnitedHealthcare before the visit (and can be backdated up to five days), though many specialties and services—including mental health, OB/GYN, radiology, therapy services, labs, preventive care, telehealth, and emergency care—are excluded from the referral requirement….
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U.S. Measles Cases Surge Past 1,100, Raising Public Health Concerns

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The Centers for Disease Control and Prevention reports more than 1,100 measles cases nationwide so far this year, putting the U.S. on pace for a record-breaking surge. As of Feb. 26, 1,136 cases had been reported—already six times higher than a typical full-year total in recent years. Health officials warn of serious complications, noting that approximately 1 in 1,000 infected children may develop encephalitis (brain swelling), and up to 3 in 1,000 may die. A…
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