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Author: Lauren Brown

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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Medicare Advantage Tensions Escalate: Why Health Systems Are Walking Away in 2026

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Hospitals and health systems are increasingly ending contracts with certain Medicare Advantage (MA) plans in 2026, reflecting growing strain between providers and insurers. As MA enrollment continues to rise—now covering more than half of Medicare beneficiaries—these decisions carry significant implications for patient access and continuity of care. At the center of this trend are ongoing operational challenges. Many providers report that prior authorization requirements frequently delay or deny medically necessary services, creating care disruptions and…
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Rural Emergency Hospitals on the Rise: What the Latest CMS Data Means

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Since Centers for Medicare & Medicaid Services introduced the Rural Emergency Hospital (REH) designation in January 2023, 50 hospitals across 21 states have transitioned to this model, signaling a major shift in how rural healthcare is delivered and sustained. The REH designation is designed to help struggling rural hospitals remain operational by focusing on emergency and outpatient services, rather than maintaining full inpatient care. This allows facilities to continue serving their communities while stabilizing financially—an…
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Understanding Denial Code PR 27: What It Means and How to Handle It

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Denial Code PR 27 indicates that a claim has been denied because the patient’s insurance coverage was no longer active on the date services were provided, making the balance the patient’s responsibility. While this may seem straightforward, it can create ripple effects across your revenue cycle—from delayed payments and increased administrative work to patient dissatisfaction if not handled proactively. These denials most commonly stem from lapsed coverage, outdated eligibility information, or missed verification of policy…
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Understanding Denial Code PR 27: What It Means & How to Prevent It

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Denial Code PR 27 signals that a claim has been denied because the patient’s insurance coverage was no longer active on the date of service, making the balance the patient’s responsibility and a potential risk to your revenue cycle. This denial most often stems from issues like lapsed coverage, outdated eligibility information, or missed verification of coverage end dates prior to treatment. In some cases, coordination of benefits changes or system errors can also trigger…
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CMS Open Payments Review Period Now Open for 2025 Data

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Centers for Medicare & Medicaid Services has opened the review period for Program Year 2025 Open Payments data, giving covered recipients an opportunity to verify submitted information before it becomes public in June. Reporting entities submitted data between February 1 and March 31, and providers are now encouraged to review records for accuracy. While participation is voluntary, reviewing this data is critical to ensuring that any reported financial relationships are accurate and properly represented. The…
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UnitedHealthcare Expands Rural Initiatives, Reduces Prior Authorizations

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UnitedHealthcare is scaling its rural healthcare initiatives nationwide, introducing faster payment timelines and easing administrative requirements for hospitals and providers in underserved areas. A key component of the expansion includes accelerating reimbursements—cutting payment timelines by up to 50%—for approximately 1,500 hospitals, including all critical access hospitals. Early results from its Rural Payment Acceleration Pilot show Medicare Advantage payments reaching hospitals in under 15 days on average, a significant improvement from traditional timelines. The program, initially…
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Community Health Systems Expands ASC Footprint Across Key Markets

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Community Health Systems is continuing to grow its ambulatory surgery center (ASC) network in 2026 through a combination of acquisitions and new facility development, reinforcing the broader industry shift toward outpatient care delivery. The system recently opened new ASCs in Alabama—including Birmingham and Foley—and expanded into Alaska with the acquisition of a majority stake in a surgery center in Anchorage, bringing its total to 36 affiliated ASCs. An additional acquisition of Surgical Institute of Alabama…
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Flu Activity Declines Nationwide, Pediatric Risk Remains Elevated

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Flu activity across the U.S. continues to trend downward, with cases and hospitalizations declining for the ninth consecutive week, according to the Centers for Disease Control and Prevention. The 2025–2026 flu season is currently classified as moderate in severity for the general population, signaling overall improvement as the season progresses. However, risk remains significantly higher for pediatric populations. The season is still considered high-severity for children, with recent reported deaths bringing the total to 143—well…
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Court Dismisses Aetna Lawsuit Over Radiology Billing Dispute

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A federal judge in the U.S. District Court for the Middle District of Florida has dismissed a lawsuit brought by Aetna against radiology providers, marking a notable development in disputes tied to the No Surprises Act. The case centered on allegations that Radiology Partners and Mori, Bean and Brooks leveraged the law’s independent dispute resolution (IDR) process to secure higher reimbursements on out-of-network claims. According to court filings, Aetna argued that tens of thousands of…
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Integrating Psychological Care to Improve Patient Outcomes

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As healthcare continues to move toward whole-person, value-based care, integrating psychological support into treatment plans is becoming increasingly essential—particularly for patients undergoing high-stress interventions such as oncology care, chronic disease management, and in-vitro fertilization (IVF). Research shows that psychological distress is not a secondary concern but a core clinical factor that directly impacts treatment adherence, decision-making, and overall outcomes. Embedding psychologists within care teams allows providers to proactively address stress, rather than treating it as…
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