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Medicare Claims Processing Update Following Government Shutdown

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After the government shutdown earlier this fall, several Medicare payment provisions expired on October 1, 2025. With the passage of the Continuing Appropriations and Extensions Act, 2026, Congress has now retroactively restored many of these policies through January 30, 2026—including key Medicare telehealth flexibilities that allow patients to receive telehealth services from home and in non-rural areas. How Claims Were Affected During the lapse, MACs processed claims based on the payment schedules available at the…
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7 Alabama Hospitals Earn CMS Five-Star Rating for Quietness

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The Centers for Medicare & Medicaid Services (CMS) has released its latest Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data, rating hospitals nationwide on patient experience — including how quiet hospital rooms are at night. Between October 2023 and September 2024, CMS surveyed patients across the country, with only 225 hospitals earning a five-star quietness rating this year — down from 313 in April. In Alabama, seven hospitals received top marks for providing…
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Cardiology faces rising demand and mounting operational pressure heading into the next decade

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Cardiology is experiencing rapid change as patient volumes grow, reimbursement tightens, and demographic shifts reshape delivery models. These five key stats highlight why many cardiology leaders expect significant pressure — and opportunity — in the years ahead: These trends point to a cardiology landscape that is growing in demand but also facing tighter margins, workforce constraints, and significant strategic shifts. Resource: 5 stats shaping cardiology’s future

Anesthesia groups face mounting pressure heading into 2026

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As anesthesia practices prepare for 2026, the specialty is confronting increasing financial and operational strain driven by reimbursement cuts, workforce shortages, and rising costs. Five key trends are shaping the outlook: These trends suggest a challenging year ahead for anesthesia services, particularly related to staffing, reimbursement, and long-term sustainability. Resource: 5 stats making anesthesia leaders nervous

Aetna delays new inpatient severity-level payment policy to 2025

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Aetna has postponed the rollout of its new “level of severity inpatient payment” policy for Medicare Advantage members, moving it from Nov. 15 to early next year. Under this approach, Aetna will automatically approve certain inpatient stays—without a medical necessity review—but pay them at a lower severity rate similar to observation status unless the stay meets Aetna’s additional inpatient criteria. The policy applies to affiliated Medicare facilities and focuses on urgent or emergent admissions lasting…
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Regional Medical Center of Central Alabama to end inpatient care as it pursues rural emergency hospital status

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Regional Medical Center of Central Alabama (RMCCA) in Greenville has announced plans to discontinue inpatient services and lay off roughly 90 employees as part of a major restructuring effort. The hospital’s board unanimously approved transitioning to a rural emergency hospital (REH) — a federal designation meant to help rural facilities stay open by focusing on emergency, outpatient, and limited on-site services rather than traditional inpatient care. According to RMCCA, the shift is driven by ongoing…
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Severe flu outbreaks across globe spur warnings for US

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Countries across the globe are reporting an unusually early and intense start to flu season, driven by a newly mutated version of the H3N2 influenza A strain. This strain, which tends to cause more severe illness—especially in older adults and young children—picked up multiple mutations over the summer. Because of these changes, it differs from the H3N2 component included in this year’s flu vaccine. The impact has been significant overseas: Experts say these trends are…
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U.S. Antibiotic Awareness Week (USAAW) Toolkit

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The U.S. Antibiotic Awareness Week (USAAW), is every November 18-24. The theme for the 2025 USAAW 2025 “Fighting Antimicrobial Resistance Takes All of Us.” The USAAW raises awareness of the importance of appropriate antibiotic and antifungal use and the threat antimicrobial resistance (AR) poses to people, animal, plants, and their shared environment. Check USAAW for daily tips this week, but also a great resource to refer back to throughout the year.

Alabama Hospitals Rank Among the Shortest ED Wait Times for Mental Health Patients

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New data from CMS’s Timely and Effective Care–Hospital dataset highlights national trends in emergency department (ED) wait times for psychiatric and mental health patients, and two Alabama hospitals ranked among the best in the country. The dataset, released August 6, evaluates ED visits from January through December 2023 and measures the median length of stay for mental health patients. Nationally, the median ED visit time was 271 minutes, up slightly from 267 minutes the previous…
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Medicare Participation Reminder for CY 2026: Decisions Due by December 31

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As the new year approaches, CMS is reminding physicians, practitioners, and suppliers to review their Medicare participation status for Calendar Year (CY) 2026. All providers must finalize their decision by December 31, 2025. Why Participation Matters Choosing to participate in Medicare offers several key advantages: Who Doesn’t Need to Take Action? No action is needed if you: Providers who want to change their Medicare participation status should visit CMS’s Annual Medicare Participation Announcement page for…
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CMS Finalizes 2026 Medicare Physician Fee Schedule: Key Updates & Reimbursement Changes

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CMS has released its final rule for the 2026 Medicare Physician Fee Schedule, including major reimbursement changes, updated conversion factors, and policy shifts affecting physician practices, ACOs, and specialty care models. 1. Two Separate Conversion Factors For 2026, CMS will use two different conversion factors: 2. New Conversion Factor Amounts 3. What Drives These Increases Each conversion factor reflects: 4. New 2.5% Efficiency Adjustment CMS finalized a –2.5% efficiency adjustment to work RVUs and physician…
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Teva Recalls Over 580,000 Bottles of Blood Pressure Medication Due to Impurity Concerns

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Teva Pharmaceuticals has issued a voluntary recall of more than 580,000 bottles of prazosin hydrochloride, a commonly prescribed blood pressure medication, after routine quality testing detected a nitrosamine impurity known as N-nitroso Prazosin impurity C. According to the FDA, long-term exposure to nitrosamines above established limits may increase the risk of cancer. The recall has been designated as Class II, meaning the likelihood of serious adverse health effects is considered remote, but temporary or medically…
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