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Humana in Focus: Leadership Changes, Legal Challenges, and Strategic Growth

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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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Study Questions CMS “Topped-Out” Measure Designations in MIPS

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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 Launches Rapid Fentanyl Test for Clinical Settings

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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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CMS Issues Key Coding & Payment Updates Across Cardiac Devices, Wellness Visits, and Lab Services

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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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CMS Releases Updated 2025 APM Participation Snapshot: What Providers Should Check Now

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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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CMS Proposes Nationwide Expansion of Joint Replacement Payment Model to Improve Outcomes and Lower Costs

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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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Recent Surgical Breakthroughs Highlight Rapid Innovation in Robotics and Minimally Invasive Care

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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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Blue Cross Blue Shield Updates Highlight Financial Pressure, Policy Shifts Across Southern States

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Blue Cross Blue Shield (BCBS) plans continue to face financial strain and policy changes across multiple states, with several developments in the South reflecting ongoing cost pressures, reimbursement adjustments, and pharmacy initiatives. Financial and Performance Trends in Southern States BCBS plans in southern states show mixed financial results as medical and pharmacy costs rise: Leadership Changes in Southern Markets Several southern BCBS-affiliated plans are experiencing executive turnover: Policy and Legal Developments Affecting Southern States Southern…
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Orlando Health Expands Alabama Presence with Planned RMC Health System Acquisition

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Orlando Health is continuing its expansion in Alabama with plans to acquire RMC Health System, a nonprofit system anchored by a 375-bed medical center and a broad network of outpatient and specialty services. The transaction, expected to close this fall, will further strengthen Orlando Health’s growing footprint in the state. This move builds on Orlando Health’s earlier investment in Brookwood Baptist Health, where it acquired a majority stake from Tenet Healthcare in 2024. With RMC…
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CMS Flags Billing Risks for E/M Services and Expands Innovation Model Flexibility

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The Centers for Medicare & Medicaid Services and the Office of Inspector General are drawing attention to improper billing practices involving evaluation and management (E/M) services billed alongside intravitreal injections. Recent findings show that modifier 25 has been incorrectly applied in cases where the E/M service was not truly separate from the procedure, increasing the risk of improper payments and audit exposure. Providers are reminded that modifier 25 should only be used when documentation clearly…
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CMS Signals Tighter Medicare Advantage Payment Growth with 2027 Rate Update

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The Centers for Medicare & Medicaid Services (CMS) has finalized a 2.48% payment increase for Medicare Advantage (MA) plans in 2027, a notable shift from prior years’ larger hikes and a clear signal of increased scrutiny on plan payments and coding practices. CMS leadership, including Chris Klomp, emphasized that sustained, high growth in MA rates is unlikely moving forward. Industry Context With nearly 35 million beneficiaries enrolled in MA plans, the program now represents a…
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CMS Innovation Models Introduce New Incentive for Clinician-Guided Hemp-Derived Product Access

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The Centers for Medicare & Medicaid Services (CMS) has launched a new, optional Substance Access Beneficiary Engagement Incentive (BEI) within select Innovation Center models, allowing participating providers to incorporate eligible hemp-derived products into patient care plans under clinician guidance. The initiative is now available to organizations in the ACO REACH Model and Enhancing Oncology Model, with expansion to the Long-term Enhanced ACO Design Model planned for 2027. Resource: CMS Marks Milestone in Expanding Patient-Centered Innovation…
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