The Centers for Medicare & Medicaid Services (CMS) has introduced a proposed rule that would extend its prior authorization interoperability framework to prescription drugs for the first time, building on its earlier efforts focused on medical services. Key Highlights for Providers: Resource: CMS proposes extension of prior authorization rule to cover drugs: 6 notes
Veteran Care & RecognitionAndalusia Health has become the first hospital in Alabama to receive designation as a Purple Heart Hospital, recognizing veterans who were wounded or killed in combat. The facility is implementing visible and ongoing initiatives—such as dedicated signage and recognition programs—to better honor and support veteran patients within its care environment. Healthcare Education & WorkforceThe University of Alabama at Birmingham (UAB) continues to strengthen its national reputation, with its Master of Science in…
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A new Mental Health Parity Index—developed by organizations including the American Medical Association—highlights ongoing disparities between mental and physical healthcare access across the U.S., despite existing parity laws. Built using transparency data from the Centers for Medicare & Medicaid Services (CMS), the tool analyzes payer networks, reimbursement, and access to care. Its findings show that 43 states still face significant gaps in access to in-network mental health and substance use disorder services. Key Trends Identified:…
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New data from the Centers for Disease Control and Prevention (CDC) shows a broader decline in respiratory illnesses across the U.S., but serious concerns remain—particularly for pediatric populations. This flu season has been especially severe for children, with 139 pediatric deaths reported, including a recent weekly increase. Notably, the majority of these cases involved unvaccinated children, reinforcing the role of immunization in preventing severe outcomes. Overall, the U.S. has seen at least 31 million flu…
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The Centers for Medicare & Medicaid Services (CMS) has published its final determinations for the HCPCS Level II Q1 2026 coding cycle, providing important updates for providers, suppliers, and billing teams. This release includes new codes, revisions, and other coding decisions that may directly impact claims submission and reimbursement. Each decision is supported by detailed documentation outlining the coding issue, a summary of the original request, and CMS’ final determination—giving providers helpful context behind each…
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Humana has made a series of notable moves in recent months, reflecting shifts in leadership, ongoing legal activity, and continued expansion efforts. On the leadership front, the company appointed Bobby Mukundan as senior vice president and chief technology officer, while Robert Field joined its board of directors—signaling a focus on technology and strategic oversight. Legal challenges remain an area to watch. Humana is involved in multiple lawsuits, including allegations tied to antitrust activity with Zelis…
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A recent study published in Health Affairs Scholar is raising concerns about how the Centers for Medicare & Medicaid Services (CMS) evaluates quality performance under the Merit-based Incentive Payment System (MIPS). Between 2017 and 2023, nearly half of MIPS quality measures were labeled as “topped out”—a designation typically used when performance is consistently high and improvement opportunities are considered limited. However, the study found that many of these measures were reported by only a small…
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Labcorp has introduced a new rapid diagnostic tool designed to detect fentanyl exposure in clinical environments. The Fentanyl Urine Visual Test, recently cleared by the U.S. Food and Drug Administration, can identify fentanyl use within a 48-hour window and delivers results in approximately 10 minutes. Built for use in emergency departments, hospitals, and clinics, this test aims to support faster clinical decision-making in situations where timely detection is critical. Its quick turnaround may help providers…
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The Centers for Medicare & Medicaid Services (CMS) has released several targeted updates impacting coding, coverage, and payment policies—areas providers should review to ensure accurate billing and planning. Cardiac Contractility Modulation (CCM) – Heart FailureCMS added new guidance tied to HCPCS codes C1824, C1898, and K1030, signaling updates for providers managing patients with heart failure using CCM devices. These changes may affect how related procedures and supplies are reported and reimbursed. Annual Wellness Visit (AWV)Updates…
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The Centers for Medicare & Medicaid Services (CMS) has released its fourth snapshot of 2025 Alternative Payment Model (APM) participation data, now available through the Quality Payment Program (QPP) Participation Status Tool. This update reflects Medicare Part B claims data for services provided throughout 2025 and offers the latest look at Qualifying APM Participant (QP) status and APM participation. For providers, this update is less about new requirements and more about verification. CMS is encouraging…
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The Centers for Medicare & Medicaid Services (CMS) is proposing a major expansion of its bundled payment approach for hip, knee, and ankle replacements through the FY 2027 Hospital Inpatient Prospective Payment System rule. The move would scale the Comprehensive Care for Joint Replacement (CJR) initiative into a nationwide model designed to improve coordination and reduce total episode costs for Medicare beneficiaries. Under the proposed CJR Expanded (CJR-X) Model, hospitals would be financially accountable for the full…
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A series of recent advancements across outpatient and hospital-based surgical settings highlights continued innovation in robotics, imaging, and minimally invasive treatment techniques. At the Advanced Surgery Center of Beverly Hills in California, physicians performed the first post-FDA-approval case using the Synergy Disc, completing a three-level cervical disc replacement shortly after the device received expanded regulatory clearance for single-level use. In ophthalmology, ForSight Robotics achieved a milestone with its JASPER Platform, enabling the world’s first fully robot-assisted cataract…
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