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Author: Lauren Brown

Must-See Updates in the MLN Connects Newsletter

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The latest MLN Connects® Newsletter from the Medicare Learning Network® is now available — your essential source for current Medicare fee-for-service policies, education, and provider guidance from CMS. Centers for Medicare & Medicaid Services Key Highlights You’ll Find Inside New DMEPOS Accreditation Changes — Finalized provisions to strengthen program integrity. Centers for Medicare & Medicaid ServicesPEPPER Relaunch — Updated Program for Evaluating Payment Patterns to support provider compliance. Centers for Medicare & Medicaid Services2026 Calendar…
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Aetna Simplifies Prior Authorization With Bundled Clinical Reviews

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Aetna is rolling out new initiatives aimed at reducing administrative burden for providers by bundling pharmacy prescriptions and medical procedures into a single clinical review, according to a Dec. 4 announcement. Previously, providers were required to submit separate prior authorizations for medical services and related medications. As of November, providers now submit one medical review, with associated medications covered under the Aetna pharmacy benefit automatically approved. As part of this effort, Aetna also introduced a…
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ACIP Recommends Shared Decision-Making for Hepatitis B Vaccination in Certain Infants

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On December 5, 2025, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted 8–3 to recommend shared clinical decision-making for parents considering the hepatitis B vaccine, including the birth dose, for infants born to women who test negative for the virus. Under this approach, parents and healthcare providers should evaluate vaccine benefits, potential risks, and an infant’s likelihood of exposure before deciding when or whether to begin the hepatitis B vaccine series. For infants who…
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How Physicians Can Reduce Risk and Respond to Stark Law Allegations

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Maintaining Stark Law compliance is critical, as violations can result in significant financial penalties, exclusion from federal healthcare programs and exposure under the False Claims Act. In a recent blog post, the Health Law Offices of Anthony Vitale outlined practical steps physicians and healthcare organizations can take to reduce risk and respond effectively to Stark Law allegations. Resource: How physicians can reduce risk and respond to Stark law allegations

Southeast Health Medical Center Earns Five-Star Recognition in Forbes’ Inaugural Rankings

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Forbes unveiled its inaugural Top Hospitals 2026 rankings on Dec. 4, evaluating U.S. general acute care hospitals based on quality, clinical outcomes, value, and patient experience. The new ranking is designed to differ from traditional hospital scorecards by relying heavily on publicly available CMS data and placing the greatest emphasis on measurable patient outcomes. According to Forbes, the methodology stands out in three key ways: it draws primarily from CMS’ Provider Data Catalog, assigns the…
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CDC Alerts Providers to Marburg Virus Outbreak in Ethiopia

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The Centers for Disease Control and Prevention (CDC) has issued a Health Alert Network (HAN) advisory regarding a new outbreak of Marburg virus disease (MVD) in Ethiopia’s South Ethiopia and Sidama regions. Marburg virus is a rare but severe hemorrhagic fever with a high fatality rate. As of December 3, 2025, no suspected, probable, or confirmed cases linked to this outbreak have been reported in the United States or in countries outside Ethiopia. The CDC…
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CMS Updates eCQI Resource Center with MIPS Value Pathway (MVP) Integration

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The Centers for Medicare & Medicaid Services (CMS) has updated the Electronic Clinical Quality Improvement (eCQI) Resource Center to strengthen continuity and connections across CMS resources. The 2026 Eligible Clinician eCQMs table now includes direct links to MIPS Quality and MIPS Value Pathways (MVPs) on the Quality Payment Program (QPP) website. New measure details include: Visit the eCQI Resource Center

CMS Releases 2026 Medicare Participation Update and Final Home Health Payment Rule

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CMS has issued two major updates for 2026: the Medicare Participation Announcement and the final rule for the CY 2026 Home Health Prospective Payment System (HH PPS). Both outline the agency’s strategic priorities for the coming year and the financial impact on home health providers. 2026 Medicare Participation Announcement CMS released its annual participation letter, reaffirming its partnership with clinicians and emphasizing Medicare’s role as one of the nation’s most impactful bipartisan programs. The agency…
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Pediatric Care Is Becoming More Complex: 6 Key Findings

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A new JAMA Network Open study analyzing more than 26 million pediatric discharges (2000–2022) shows a major shift in the intensity, cost, and location of pediatric inpatient care — especially for children with complex chronic conditions. 1. Sharp rise in medically complex cases Hospital discharges for children with at least one complex chronic condition increased 24.3%, while discharges for children without chronic conditions fell 9.7%, signaling a growing concentration of medically complex patients. 2. Higher…
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What Providers Need to Know About Final 2025 MIPS Eligibility & Preparing for 2026

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Check Final 2025 MIPS Eligibility Status Enter your 10-digit National Provider Identifier (NPI) in the Quality Payment Program (QPP) Participation Status Tool and review your final 2025 eligibility status for the Merit-based Incentive Payment System (MIPS).  We’ve updated your eligibility status based on our review of Medicare Part B claims and Medicare Provider Enrollment, Chain, and Ownership System (PECOS) data from the second segment of the MIPS Eligibility Determination Period (October 1, 2024 – September 30, 2025).  Review Your 2025 Eligibility…
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CRI Physician Services Planning for 2026

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CRI has summarized CMS’s newly released telehealth guidance following the 43-day government shutdown. The update confirms retroactive payments for eligible shutdown-period claims, outlines telehealth flexibilities set to expire Jan. 30, and clarifies practice-location requirements for home-based and virtual-only clinicians. Full details are available in the attached CMS FAQ. Resource: CRI Physician Services Planning for 2026

CMS Finalizes 1.3% Payment Cut for Home Health in 2026: 8 Key Updates

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CMS has finalized a 1.3% decrease in home health payments for 2026, part of its annual Home Health Prospective Payment System update released Nov. 28. The rule includes permanent and temporary payment adjustments tied to the Patient-Driven Groupings Model (PDGM) and several policy changes aimed at easing administrative burdens while strengthening fraud prevention. Here are the eight main updates: Resource: CMS cuts home health pay: 8 things to know