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CMS Publishes CY 2023 QPP Performance Information

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The Centers for Medicare & Medicaid Services (CMS) has released calendar year (CY) 2023 Quality Payment Program (QPP) performance information for clinicians, groups, virtual groups, and Accountable Care Organizations (ACOs). This data is now available in the Provider Data Catalog (PDC) and on clinician and group profile pages in the Medicare.gov Care Compare tool. The publicly reported information includes final Merit-based Incentive Payment System (MIPS) scores across each performance category, the names of Advanced Alternative…
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CMS Updates QPP Tools and Resources for 2025 and 2026

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CMS has released several updates to the Quality Payment Program (QPP), including new APM participation snapshots, approved registries for the 2026 performance year, website enhancements, and rural status updates. These changes are intended to help clinicians and organizations verify participation status and prepare for upcoming reporting requirements. New 2025 APM Participation Snapshots Available CMS updated the QPP Participation Status Tool using the second and third snapshots of 2025 APM data. The tool reflects Qualifying APM Participant (QP)…
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An Alabama Hospital Recognized on Becker’s 2025 “Great Hospitals in America” List

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Becker’s Hospital Review has released its 2025 “Great Hospitals in America” list, recognizing hospitals nationwide for exceptional clinical performance, patient safety, and a strong commitment to innovation, research, and education. These organizations have also earned distinction from leading rankings and accreditation bodies such as U.S. News & World Report, Healthgrades, CMS, and The Leapfrog Group. UAB Hospital in Birmingham was the only hospital in Alabama to make the 2025 list, highlighting the state’s representation among…
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CMS Proposes Two New Medicare Drug Pricing Models to Reduce Costs

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CMS has proposed two new drug pricing models designed to reduce Medicare spending by linking U.S. payments to international pricing benchmarks. Announced by the CMS Innovation Center, the proposals—GUARD and GLOBE—aim to improve affordability for beneficiaries while supporting the long-term sustainability of the Medicare program. Key elements of the proposal include: Resource: CMS proposes 2 Medicare drug pricing models

CMS Releases Updated 2026 QRDA III Implementation Guide for Eligible Clinicians

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CMS has published the updated 2026 Quality Reporting Document Architecture (QRDA) Category III Implementation Guide (IG) for Eligible Clinicians, incorporating changes finalized in the 2026 Medicare Physician Fee Schedule (PFS) Final Rule released on October 31, 2025. The updated guide outlines technical and reporting requirements for submitting electronic clinical quality measures (eCQMs) for Calendar Year 2026 quality programs. Key updates include the addition of new MIPS Value Pathway (MVP) identifiers across several specialties, new eCQM…
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CMS Releases 2026 QCDR Measure Specifications for MIPS Reporting

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CMS has published the 2026 Qualified Clinical Data Registry (QCDR) Measure Specifications, providing clinicians and organizations with an early look at quality measures available for the upcoming MIPS performance year. Released on December 22, 2025, the specifications allow clinicians, groups, virtual groups, subgroups, and APM Entities—including Medicare Shared Savings Program ACOs—to identify QCDR measures that align with their specialty and reporting needs. The file includes a full list of CMS-approved QCDR measures and identifies which…
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CMS Releases Latest Medicare Diabetes Prevention Program (MDPP) Bulletin

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The Centers for Medicare & Medicaid Services (CMS) has released the latest edition of the Medicare Diabetes Prevention Program (MDPP) Bulletin, the agency’s quarterly newsletter for the MDPP community. Published by the CMS MDPP Team, the bulletin provides updates, resources and insights to support organizations and professionals working to prevent or delay the onset of Type 2 diabetes among Medicare beneficiaries. This edition includes: CMS encourages MDPP suppliers to review the newsletter and share it…
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CMS Updates eCQI Resource Center With MIPS Value Pathway Integration

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The Centers for Medicare & Medicaid Services (CMS) has updated the Electronic Clinical Quality Improvement (eCQI) Resource Center to better connect quality reporting resources across CMS programs. As part of the update, the 2026 Eligible Clinician eCQM table now includes direct links to MIPS Quality measures and MIPS Value Pathways (MVPs) on the Quality Payment Program website. The enhanced measure details help clinicians and practices more easily align their reporting strategies and include traditional MIPS…
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Must-See Updates in the MLN Connects Newsletter

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The latest MLN Connects® Newsletter from the Medicare Learning Network® is now available — your essential source for current Medicare fee-for-service policies, education, and provider guidance from CMS. Centers for Medicare & Medicaid Services Key Highlights You’ll Find Inside New DMEPOS Accreditation Changes — Finalized provisions to strengthen program integrity. Centers for Medicare & Medicaid ServicesPEPPER Relaunch — Updated Program for Evaluating Payment Patterns to support provider compliance. Centers for Medicare & Medicaid Services2026 Calendar…
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Aetna Simplifies Prior Authorization With Bundled Clinical Reviews

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Aetna is rolling out new initiatives aimed at reducing administrative burden for providers by bundling pharmacy prescriptions and medical procedures into a single clinical review, according to a Dec. 4 announcement. Previously, providers were required to submit separate prior authorizations for medical services and related medications. As of November, providers now submit one medical review, with associated medications covered under the Aetna pharmacy benefit automatically approved. As part of this effort, Aetna also introduced a…
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ACIP Recommends Shared Decision-Making for Hepatitis B Vaccination in Certain Infants

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On December 5, 2025, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted 8–3 to recommend shared clinical decision-making for parents considering the hepatitis B vaccine, including the birth dose, for infants born to women who test negative for the virus. Under this approach, parents and healthcare providers should evaluate vaccine benefits, potential risks, and an infant’s likelihood of exposure before deciding when or whether to begin the hepatitis B vaccine series. For infants who…
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How Physicians Can Reduce Risk and Respond to Stark Law Allegations

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Maintaining Stark Law compliance is critical, as violations can result in significant financial penalties, exclusion from federal healthcare programs and exposure under the False Claims Act. In a recent blog post, the Health Law Offices of Anthony Vitale outlined practical steps physicians and healthcare organizations can take to reduce risk and respond effectively to Stark Law allegations. Resource: How physicians can reduce risk and respond to Stark law allegations