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Author: Lauren Brown

Audit Finds Potential Medicare Advantage Overpayments for BCBS Alabama

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A recent audit from the HHS Office of Inspector General (OIG) estimates that Blue Cross Blue Shield of Alabama may have received at least $7 million in Medicare Advantage overpayments. The findings are based on a review of 271 enrollee-years, where the majority showed discrepancies between submitted diagnosis codes and supporting medical records. These inconsistencies led to approximately $769,000 in identified overpayments within the sample, which OIG used to project the larger total. The audit…
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States Move to Regulate AI in Coverage Decisions, Emphasizing Human Oversight

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Lawmakers in both Louisiana and Georgia are advancing legislation that would limit how artificial intelligence is used in health insurance coverage decisions—signaling a broader push to ensure clinical judgment remains central in patient care. In Louisiana, proposed legislation would require that any denial, delay, or modification of care involving AI must include independent human review. A qualified clinician would need to evaluate the case and, in many instances, a physician would be required to personally…
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Rising Measles Cases in the U.S. Highlight Growing Public Health Concerns

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New data from the Centers for Disease Control and Prevention shows a continued rise in measles cases across the United States, with totals climbing into the 1,300–1,400+ range as of mid-to-late March 2026. Recent updates noted at least 1,362 confirmed infections, with numbers continuing to increase to 1,487 cases by March 19. The majority of these cases are tied to outbreaks, with 14 identified so far in 2026 and approximately 94% of cases linked to…
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CMS Moves Toward Fully Electronic Claims Processing, Reducing Administrative Burden

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The Centers for Medicare & Medicaid Services (CMS) has finalized a new rule aimed at modernizing how healthcare providers submit claims documentation—replacing outdated methods like faxing and mailing with standardized electronic transactions. At the core of this update is the adoption of national standards for electronic claims attachments and secure electronic signatures. These changes are designed to simplify how providers share supporting documentation—such as medical records, lab results, and clinical notes—with health plans. By creating…
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Ipsen Withdraws Cancer Drug Tazverik from U.S. Market Over Safety Concerns

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Ipsen is voluntarily removing its cancer therapy Tazverik from the U.S. market due to safety concerns. An ongoing clinical trial reported secondary hematologic malignancies, serious blood cancers, suggesting that the risks may outweigh potential benefits for patients. Tazverik received accelerated approval from the FDA in 2020 to treat epithelioid sarcoma, a rare soft tissue cancer, and relapsed or refractory follicular lymphoma, a type of non-Hodgkin lymphoma. The voluntary withdrawal applies to all approved indications. Resource:…
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Measles Cases Surge in 2026, CDC Reports 1,281 Infections

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Measles infections in the U.S. are rising sharply in 2026, with the Centers for Disease Control and Prevention reporting 1,281 cases so far—a jump of 145 cases since the last update. If trends continue, the total could surpass 2025’s 2,258 cases. Most infections occur in children and young adults under 19, with the majority of patients either unvaccinated or having unknown vaccination status. States including Texas and Utah are current hot spots, and 12 measles…
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Study Finds Medicare Beneficiaries Average 60 Million Telehealth Visits Annually

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A recent study published in the Annals of Internal Medicine found that Medicare beneficiaries completed about 60 million telehealth visits annually between 2021 and 2023, highlighting the continued role of virtual care following the pandemic. According to research led by Terrence Liu of the University of Utah, roughly 31 million visits were related to mental health services, while about 29 million were for other medical concerns. The analysis drew on data from the Medical Expenditures…
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CMS Updates: Lab Reporting Requirements and 2026 Payment Adjustment Corrections

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The Centers for Medicare & Medicaid Services recently shared updates impacting laboratories and clinicians participating in the Quality Payment Program (QPP). Clinical Diagnostic Laboratory Reporting Independent laboratories, physician office labs, and hospital outreach labs that qualify as applicable laboratories under the Clinical Laboratory Fee Schedule (CLFS) must report private payor data between May 1 and July 31, 2026. The reporting period will include data collected from January 1 through June 30, 2025, including applicable HCPCS…
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Congress Extends Hospital-at-Home Waiver Through 2030, Including Programs in Alabama

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Congress has extended the Acute Hospital Care at Home waiver for five additional years through the Consolidated Appropriations Act of 2026, allowing hospitals to continue providing inpatient-level care to eligible Medicare patients in their homes. The program, originally launched by the Centers for Medicare & Medicaid Services during the COVID-19 public health emergency, allows approved hospitals to treat certain patients at home while maintaining hospital-level monitoring and physician oversight. More than 370 hospitals nationwide currently…
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8 EHR Changes That Could Save Physicians Hours Each Day

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The American Medical Association highlights several simple adjustments practices can make to their electronic health record (EHR) systems that may significantly reduce administrative burden and physician burnout. The recommendations come from the AMA’s STEPS Forward® de-implementation checklist, which focuses on eliminating low-value tasks that do not improve patient care. Key suggested improvements include: According to the AMA, even small workflow changes can free up significant time—allowing physicians to spend more time with patients and less…
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BCBS Michigan Revises Modifier 25 Policy Ahead of May 2026 Implementation

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Blue Cross Blue Shield of Michigan has updated its policy that will reduce reimbursement for certain evaluation and management (E/M) services billed with modifier 25 on the same day as procedures. Beginning May 1, 2026, the insurer plans to reduce payment by 50% for non-preventive E/M services billed with modifier 25 when performed alongside minor procedures with global periods of 0 or 10 days. The payer clarified that 90-day global procedures were mistakenly included in…
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Eli Lilly Introduces Direct-to-Employer Platform for Zepbound Coverage

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Eli Lilly and Company has launched Employer Connect, a new platform designed to give employers a direct pathway to offer coverage for the weight-loss medication Zepbound outside traditional pharmacy benefit structures. Through the platform, employers can work with independent program administrators—such as Calibrate Health, Teladoc Health, GoodRx, and Cost Plus Drugs—to design obesity treatment benefits for employees. Under the program, Zepbound will be available at a list price of $449 per month for all doses…
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