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 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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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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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 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 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
UnitedHealthcare has outlined several updates to its Medicare Advantage plans for 2026, including new referral requirements and changes to supplemental benefit eligibility. 1. Most HMO and POS plans will require referrals.Beginning Jan. 1, 2026, members enrolled in UnitedHealthcare Medicare Advantage HMO and POS plans will need a referral from their primary care provider before seeing certain specialists in outpatient, office, or home settings. PCPs must submit the referral to UnitedHealthcare prior to the specialist visit….
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CMS has issued updated telehealth guidance following the end of the 43-day federal government shutdown, offering clarity for providers navigating billing and enrollment rules. Here are the four main takeaways from CMS’s November FAQ: Resource: CMS issues new telehealth guidance: 4 notes
Flu activity across the U.S. remains relatively low but is beginning to increase — especially among children and young adults — according to the CDC’s latest FluView report published Dec. 1. In the week ending Nov. 22, flu-related hospitalizations rose sharply to 3,264, a 39% jump from the previous week. Outpatient visits for flu-like illness also edged up to 2.5%, still below the national baseline of 3.1%. Young children (ages 4 and under) continue to…
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Hospitals are beginning to see a gradual uptick in respiratory syncytial virus (RSV) admissions, although national numbers remain limited due to delayed federal reporting. Cincinnati Children’s Hospital is among those noting earlier-than-usual activity, with Hamilton County recording 32 RSV admissions in the week ending Nov. 15 — slightly up from 28 the week prior. National CDC estimates, last updated Oct. 25, show RSV hospitalizations remain low at 0.2 per 100,000 people, but are trending upward….
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CMS has announced the 2026 cost updates for Medicare Parts A and B, outlining new deductible and coinsurance amounts that will take effect next year. These changes impact inpatient hospital stays, skilled nursing facility care, and outpatient services. Medicare Part A – Inpatient Hospital Costs The Part A inpatient hospital deductible will increase to $1,736 in 2026, up from $1,676 in 2025. This deductible applies to the first 60 days of Medicare-covered inpatient care.For longer…
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CMS is modernizing the Clinical Laboratory Improvement Amendments (CLIA) program by shifting from mailed paper fee coupons and certificates to fully electronic delivery. Beginning March 1, 2026, laboratories and providers that perform lab testing must opt in to receive CLIA certificates and fee notices by email. After this date, CMS will no longer send paper versions. To transition to electronic notifications, labs can choose one of three options: This new process does not apply to…
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