CMS’ proposed 2027 Medicare Physician Fee Schedule includes several payment changes that could affect physician reimbursement: Practices should review the proposed changes and consider how specialty-specific reimbursement adjustments could affect their billing and financial planning. Resource: The proposed 2027 Medicare physician pay cuts, by specialty
U.S. Measles Cases Exceed 4,400 as Vaccination Rates Decline The U.S. has recorded 4,410 measles cases in 2026, already nearly double the 2,289 cases reported in all of 2025. The continued rise in infections comes as MMR vaccination rates among kindergarteners have fallen below the 95% coverage level considered necessary to prevent widespread outbreaks. The increase highlights the importance of maintaining vaccination coverage and monitoring preventable infectious diseases. FDA Expands Automated Insulin Delivery System Approval…
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CMS has released the 2027 Medicare Advantage and Part D Star Ratings, with Humana reporting significant improvements in its plan performance. Approximately 95% of Humana’s Medicare Advantage members are expected to be enrolled in plans rated four stars or higher, compared to lower results from several competing insurers. The company attributed its improvement to stronger performance across quality measures, preventive care, and member engagement. UnitedHealthcare saw its share of members in plans rated four stars…
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For the fifth consecutive year, Physicians Mutual has been recognized by Forbes as one of America’s Best Insurance Companies for 2027. The recognition is based on an independent survey of more than 18,000 consumers who evaluated insurance companies on customer satisfaction, service, pricing, transparency, digital services, and claims or benefit experiences. The annual rankings were conducted in partnership with Statista and considered customer loyalty, overall satisfaction, and willingness to recommend their insurance provider. Physicians Mutual’s…
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Humana Military has earned its eighth consecutive Center of Excellence certification from BenchmarkPortal for its customer service operations supporting TRICARE East Region beneficiaries. The recognition is based on contact center performance, including customer satisfaction, efficiency, and effectiveness, with certified centers ranking among the top 10% of those evaluated. Humana Military was also ranked among the top three large contact centers in BenchmarkPortal’s 2026 Top Contact Centers Contest. The recognition highlights the company’s continued focus on…
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CMS has updated the Quality Payment Program (QPP) Participation Status Tool with the second 2026 snapshot of Alternative Payment Model (APM) participation data. The update includes Qualifying APM Participant (QP) status and MIPS APM participation information based on Medicare Part B claims from the first half of 2026. Providers can use the online tool to check their current status by entering their 10-digit National Provider Identifier (NPI). CMS encourages providers to verify their organization and…
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Prostate Cancer Screening: CMS encourages providers to discuss prostate cancer screening with male patients and review Medicare coverage and eligibility requirements. Prostate cancer is the second leading cause of cancer deaths in men, making preventive screening discussions an important part of patient care. Providers can use Medicare resources to verify patient eligibility and understand available screening coverage. Optometry Billing Compliance: An HHS Office of Inspector General (OIG) audit found improper Medicare payments for high-level evaluation and management…
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2026 MIPS MVP Registration Open Through November 30 CMS Updates: 2026 MIPS Registration and QPP Exception Applications CMS has opened the 2026 Merit-based Incentive Payment System (MIPS) Value Pathway (MVP) registration period for individual clinicians, groups, subgroups, and Alternative Payment Model (APM) Entities. Registration or changes to an existing registration must be completed by November 30, 2026, at 8 p.m. ET through the Quality Payment Program (QPP) website. Practices should review their reporting options, as participants registered for an MVP may also submit traditional MIPS…
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CMS has released the Preliminary Calendar Year (CY) 2026 Annual Performance Reports (APRs) for the expanded Home Health Value-Based Purchasing (HHVBP) Model through the iQIES system. The reports evaluate home health agencies’ performance during 2025 and show their Total Performance Scores, quality measure results, and Adjusted Payment Percentages (APPs), which will determine Medicare fee-for-service payment adjustments for 2027. Performance is measured across 10 quality measures covering patient outcomes, hospitalizations, discharge results, and patient experience. Eligible…
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Alabama is receiving nearly $55 million in federal funding through the Rural Health Transformation Program to support 34 projects focused on improving healthcare access and strengthening rural communities. The investment will help equip rural hospitals with emergency labor and delivery resources, expand access to maternal-fetal medicine through telehealth, improve emergency response and EMS coordination, and bring mobile cancer screenings and early detection services to more communities. Additional funding will support healthcare workforce development through expanded training opportunities, educational partnerships, and recruitment efforts…
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Medicare generally denies duplicate laboratory tests that are not medically necessary, so practices should review panel contents before ordering additional individual tests; when repeat testing is medically necessary, modifier 91 may apply. For telehealth services provided to patients in the Acute Hospital Care at Home program, Medicare considers the patient an inpatient, so providers should report POS 21 with modifier 95. CMS resources provide additional billing and coding guidance for both situations. Resource: MLN Connects® Newsletter
CMS reviewed the 2026 MIPS quality measures for the annual ICD-10 code changes that took effect October 1. No MIPS quality measures were identified as significantly affected, meaning no measures will be suppressed or have their performance period shortened because of the 2026 ICD-10 updates. CMS evaluates whether coding changes could affect a measure’s scope, intent, clinical applicability, or historical benchmarks. When significant changes are identified, CMS may either exclude the measure from scoring or limit…
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