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Author: Lauren Brown

Key CMS & Medicare Updates Providers Should Know

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Several recent CMS and Medicare updates may impact laboratory operations, billing compliance, and coverage requirements. Below is a high-level overview of what’s changing and where providers should pay close attention. CLIA Program: Paper Fee Coupons & Certificates Ending March 1 Centers for Medicare & Medicaid Services is transitioning the CLIA program to fully electronic communications. After March 1, 2026, paper CLIA fee coupons and certificates will no longer be mailed, and payments must be made…
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Alabama Anesthesiologist Appointed to Leadership Role at UAB

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Anesthesiologists’ continuous involvement throughout the perioperative process gives them a uniquely broad perspective on operating room efficiency and patient care — positioning many to step into leadership roles across health systems and ambulatory surgery centers. Among recent national leadership appointments reported by Becker’s, Matthew Sherrer, MD, an associate professor in the Department of Anesthesiology at UAB Health System, has been named assistant dean for faculty affairs. Dr. Sherrer’s appointment highlights Alabama’s continued representation in academic…
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Study Finds Many Patients Prefer Remote Consults for Ongoing Care

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A recent study published in JAMA Network Open, and reported by The American Journal of Managed Care, found that more than half of patients with long-term conditions prefer remote consultations over in-person visits in certain scenarios. Overall, 37% of surveyed patients preferred remote care across multiple clinical situations, with synchronous methods (such as video or phone visits) favored over asynchronous messaging. Preference for remote care was highest when discussing test results (43%) and renewing medications…
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CVS Pharmacies Begin Accepting TrumpRx Discount Cards

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CVS Health’s nearly 9,000 community pharmacies are now accepting TrumpRx discount cards as of Feb. 6, expanding access to savings on select medications for eligible patients. The discounts are determined by participating drug manufacturers, and patients can present a printed card at the pharmacy counter to receive applicable price reductions. In addition, CVS Specialty Pharmacy is participating in the TrumpRx Fertility program, offering reduced pricing on certain fertility medications. As discount programs and alternative pricing…
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Medicare Part D to Cover Weight-Loss Treatments Beginning in 2027

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Starting in 2027, participating Medicare Part D plans may begin covering weight-loss medications under CMS’ voluntary BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) model. The announcement follows federal negotiations aimed at securing more favorable pricing for obesity and diabetes treatments. Recent data analysis from KFF, based on CMS data from 2019–2024, shows a dramatic rise in GLP-1 medication use and spending among Medicare beneficiaries. Use of Ozempic grew from fewer than 150,000…
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FTC Reaches Settlement with Express Scripts Over Insulin Pricing

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The Federal Trade Commission (FTC) has reached a settlement with Express Scripts, Cigna’s pharmacy benefit manager (PBM), in a case centered on alleged insulin price inflation. The agreement is expected to reduce out-of-pocket drug costs — including insulin — by an estimated $7 billion over the next decade. Under the settlement, Express Scripts must delink manufacturer compensation from drug list prices, avoid favoring higher-priced drugs over lower-cost alternatives, and ensure patient cost-sharing is based on…
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Key CMS Billing and Payment Updates for 2026

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CMS released several updated MLN Matters® articles outlining important billing, payment, and coverage changes taking effect in 2026. These updates impact ESRD facilities, ambulatory surgical centers, rural health clinics, and preventive services. Acute Kidney Injury & ESRD Billing UpdatesBeginning July 1, 2026, ESRD facilities will no longer be required to submit the AX modifier on certain ESRD PPS claims eligible for add-on payment adjustments. CMS also issued new billing instructions for hemodiafiltration and acute kidney…
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Federal Budget Deal Delivers Key Healthcare Wins—With Major Telehealth Extension

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The latest federal budget agreement includes several healthcare provisions supported by the American Medical Association, delivering meaningful updates for physicians and patients. Among the most impactful outcomes is a renewed commitment to telehealth access, along with additional reforms focused on care delivery, physician support, and cost transparency. 1. Medicare telehealth coverage extended for two yearsMedicare telehealth flexibilities have been renewed through 2027, restoring continuity of care after a 43-day lapse tied to the 2025 government…
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Understanding the Stark Law In-Office Ancillary Services Exception

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The in-office ancillary services exception is one of the most commonly used Stark Law exceptions, allowing physician practices to provide designated health services—such as labs, imaging, and therapy—within the practice without violating self-referral rules. Compliance, however, depends on meeting several technical requirements where practices often get tripped up: 1. Three core requirements must be metServices must be provided under appropriate physician supervision, furnished in the group’s office or a centralized patient-care location, and billed by…
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CMS Finalizes Separate Medicare Payment for Non-Opioid Pain Devices in ASCs

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CMS has confirmed that ambulatory surgery centers will continue to receive separate Medicare reimbursement in 2026 for certain non-opioid pain management devices under the NOPAIN Act, including three approved products used in ASC and outpatient hospital settings. The decision reinforces ongoing efforts to support non-opioid pain management options following surgical procedures when medically necessary. Resource: CMS finalizes separate payment for 3 non-opioid ASC pain devices

Measles Cases Rise Early in 2026, Prompting Public Health Concern

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Just one month into 2026, the U.S. has already reported 588 confirmed measles cases—about 25% of the total cases recorded in all of 2025—raising concerns that this year could surpass recent annual totals if current trends continue. Several states are experiencing significant outbreaks, with discrepancies between state-reported and federally confirmed case counts, and public health officials are monitoring whether sustained transmission could impact the U.S.’s long-standing measles elimination status. Resource: 1 month into 2026, measles…
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Overview of Alabama’s Medical Cannabis Physician Certification Process

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The Alabama Medical Cannabis Commission has begun issuing dispensary licenses, allowing the Board of Medical Examiners (BME) to accept applications from physicians seeking certification to recommend medical cannabis. Under Alabama requirements, physicians must complete a four-hour medical cannabis education course and pass a subsequent examination to become a registered certifying physician. A two-hour refresher course is required every two years to maintain certification. All required coursework and examinations are administered through the Medical Association. The…
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