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10 Key Things Providers Should Know About the Stark Law

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The Stark law remains one of the most significant federal regulations governing financial relationships in healthcare. It aims to prevent fraud and abuse by prohibiting physician self-referrals for certain Medicare and Medicaid services. A recent overview from the law firm Eisner Gorin highlights several important updates and reminders for providers. What the Stark Law Covers The law bars physicians from referring Medicare or Medicaid patients for designated health services to any entity with which they…
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CMS Publishes 2026 Policy Changes for the Quality Payment Program

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The Centers for Medicare & Medicaid Services (CMS) has released the 2026 Medicare Physician Fee Schedule (PFS) Final Rule, outlining updates to the Quality Payment Program (QPP) for the 2026 performance year and beyond. The rule will be officially published on November 5, 2025, in the Federal Register. CMS emphasized program stability while continuing the shift toward MIPS Value Pathways (MVPs) and greater alignment across programs. Merit-based Incentive Payment System (MIPS) MVPs (MIPS Value Pathways)…
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Blue Cross and Blue Shield of Alabama: Upcoming Drug Policy Updates

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Effective January 1, 2026, prior authorization will be required for all denosumab products, including biosimilars, for commercial Blue Cross of Alabama members. For PEEHIP plans, beginning October 1, 2025, the same preferred products apply. All other denosumab versions will be non-covered, with proactive authorizations added for current patients. Additional PEEHIP medical drug updates (effective Jan. 1, 2026) include changes to coverage and preferred products across multiple drug classes, such as myasthenia gravis therapies, pegfilgrastim, trastuzumab,…
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New CMS Model Aims to Cut Prescription Costs and Expand Access in Medicaid

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The Centers for Medicare & Medicaid Services (CMS) has introduced a new initiative aimed at lowering prescription drug costs and improving access to critical medications for Medicaid beneficiaries. The GENErating cost Reductions fOr U.S. Medicaid (GENEROUS) Model, set to launch in 2026, will allow participating states to purchase certain drugs at internationally competitive prices to reduce spending and promote affordability. The model encourages state Medicaid programs and drug manufacturers to collaborate on transparent, uniform pricing…
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CMS Issues Update on Medicare Telehealth Payment Limitations

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As of October 1, 2025, many of the temporary telehealth flexibilities introduced during the COVID-19 Public Health Emergency have expired, following the absence of new Congressional action. This means several statutory payment restrictions under Medicare are now back in effect, including: Certain services remain exempt, including behavioral and mental health, monthly ESRD-related clinical assessments, and telehealth provided by Medicare Shared Savings Program ACOs. To comply with current law, CMS has directed Medicare Administrative Contractors (MACs)…
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CMS: All 50 States Apply for $50 Billion Rural Health Transformation Program

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The Centers for Medicare & Medicaid Services (CMS) announced that all 50 states have applied for the new $50 billion Rural Health Transformation Program, a landmark initiative to improve access, quality, and sustainability of care in rural communities across the U.S. Created under the Working Families Tax Cuts legislation (Public Law 119-21), the program empowers states to design and implement customized plans that address local health challenges and expand care access for rural populations. The…
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UAB Hospital Among Elite Group with Five or More Magnet Designations

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Less than 2% of the nation’s 6,093 hospitals have earned Magnet designation at least five times, according to the American Nurses Credentialing Center (ANCC). The Magnet program recognizes hospitals for nursing excellence, quality patient care, and innovations in professional practice. Of the nearly 650 Magnet-recognized hospitals worldwide, only 112 have achieved this distinction five or more times — and UAB Hospital in Birmingham is among them, with an impressive six Magnet designations. This recognition highlights…
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Will RVUs Survive in a Value-Based Future?

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Relative value units (RVUs) have long been the standard for measuring physician productivity and determining compensation. But as healthcare moves toward value-based care, the traditional RVU model faces growing scrutiny. RVUs, established in the late 1980s, account for work effort, practice expenses, and malpractice costs, and remain central to how CMS and health systems calculate reimbursement. Yet despite rising workloads, physician productivity increased 12% year over year in 2025, according to Kaufman Hall, while reimbursement…
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Alabama Hospitals Among Lowest in Nation for Unplanned Readmissions After Outpatient Surgery

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According to new CMS 2023 data, five hospitals across the U.S. achieved the lowest ratio of unplanned hospital visits after outpatient surgery — just 0.4. The dataset, updated August 6, tracks hospital return days, unplanned readmissions, and other quality measures following outpatient procedures. Three Alabama hospitals ranked among those with some of the lowest readmission ratios nationwide, reflecting the state’s strong performance in post-surgical care quality: These results underscore Alabama hospitals’ continued focus on patient…
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A New Era in Cancer Screening: What Leaders Should Know About Multi-Cancer Early Detection (MCED)

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Cancer is projected to claim 618,000 lives in the U.S. in 2025, according to the American Cancer Society. Despite advances in treatment, most deaths occur from cancers that don’t currently have guideline-recommended screening tests. Today, the CDC recommends screening for only four cancers — breast, cervical, colorectal, and lung — leaving two-thirds of cancers undetected until symptoms appear. Once cancers reach these later stages, treatments are less effective and survival rates drop significantly. That gap…
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Best and Worst U.S. States for Obesity: 2025 Report

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A new report from Trust for America’s Health (TFAH) highlights a slight national improvement in adult obesity rates, though overall prevalence remains high across the United States. The report, The State of Obesity: 2025, draws on data from the CDC and the National Health and Nutrition Examination Survey (NHANES). In 2024, 19 states reported adult obesity rates at or above 35%, compared to 23 states in 2023. Still, more than 4 in 10 U.S. adults…
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Global Antibiotic Resistance Surveillance Report 2025

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A new report from the World Health Organization (WHO) highlights a sharp rise in antibiotic resistance worldwide, signaling growing challenges for infection control and treatment. The 2025 Global Antibiotic Resistance Surveillance Report, drawing on data from more than 100 countries, analyzed 22 antibiotics used to treat eight common bacterial pathogens through the Global Antimicrobial Resistance and Use Surveillance System (GLASS). Key Findings WHO Director-General Dr. Tedros Adhanom Ghebreyesus cautioned that “antimicrobial resistance is outpacing advances…
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