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Three New CDC Reports on the 2024–2025 Flu Season

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CDC has released three new reports on the impact and severity of the 2024–2025 flu season in the United States, which was the most severe since 2017–2018. The reports highlight the effects of flu on children, the seriousness of pediatric complications, and the viruses that circulated most widely last season. Key Findings: Flu Vaccine Guidance:CDC continues to recommend that everyone 6 months and older receive a flu vaccine, ideally by the end of October. Vaccination…
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Alabama Hospitals Earn CMS 5-Star Cleanliness Ratings

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CMS has released its latest Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results, highlighting hospitals nationwide that received a 5-star rating for cleanliness. The survey reflects patient experiences between Oct. 1, 2023 – Sept. 30, 2024, with data updated on Aug. 6, 2025. We’re proud to share that four Alabama hospitals earned this top recognition: MediSYS congratulates these Alabama hospitals on their commitment to patient care and the exceptional work that led…
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Cigna to Implement E/M Coding Accuracy Policy Oct. 1

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Beginning October 1, Cigna will enforce a new Evaluation and Management (E/M) Coding Accuracy policy. The policy targets CPT codes 99204–99205, 99214–99215, and 99244–99245, reviewing claims for documentation accuracy. If supporting documentation does not meet AMA guidelines, services may be downgraded by one level. The move has faced opposition from Sen. Richard Blumenthal and the California and Texas medical associations, who have called on Cigna to reverse the policy. According to a Cigna spokesperson, the…
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Shutdown Impact on Medicare: Telehealth, Claims Processing, and Contractor Updates

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When certain legislative payment provisions (“extenders”) are set to expire, CMS directs Medicare Administrative Contractors (MACs) to place a temporary hold—typically up to 10 business days—on claims. This standard practice helps ensure payments remain accurate with statutory requirements and avoids the need to reprocess large volumes of claims if Congress acts after expiration. Providers may continue submitting claims during this period; payments will be released once the hold is lifted. Without Congressional action, beginning October…
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UnitedHealthcare’s September 2025

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UnitedHealthcare’s September 2025 bulletin announces the delayed implementation of a policy cutting reimbursements for off-campus provider-based departments, new routine lab testing policies with automated pre-payment reviews effective December 1, 2025, and updates to imaging, anesthesia, and procedure place‐of‐service reimbursement rules. https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/rpub/UHC-COMM-RPUB-September-2025.pdf

AHIP Statement on Vaccine Coverage

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AHIP released the following statement on September 16, 2025, regarding vaccine coverage. “Health plans are committed to maintaining and ensuring affordable access to vaccines. Health plan coverage decisions for immunizations are grounded in each plan’s ongoing, rigorous review of scientific and clinical evidence, and continual evaluation of multiple sources of data. “Health plans will continue to cover all ACIP-recommended immunizations that were recommended as of September 1, 2025, including updated formulations of the COVID-19 and…
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CMS & CDC Updates: Lab Fee Schedule, Hepatitis C Screening, and Ebola Advisory

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Clinical Laboratory Fee Schedule: COVID-19 & Influenza Virus Types A and B Test Code For combination tests that are read visually, CPT code 87812 QW will take effect on January 1, 2026. Until then, laboratories may bill CPT code 87428 QW. Medicare Claims Processing Manual, Chapter 18 Update: Hepatitis C Virus Preventive & Screening Services Learn about hepatitis C virus updates (PDF) to the Medicare Claims Processing Manual, effective June 27, 2024:  From Our Federal Partners: Ebola Outbreak in the…
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2024 MIPS Targeted Review Now Open

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Clinicians and organizations can now review their 2024 MIPS final scores on the Quality Payment Program website (QPP) and, if needed, request a targeted review. A targeted review allows CMS to re-examine your score if you believe there’s an error—for example, incorrect TIN/NPI data, misapplied performance category reweighting, or if you qualify as a QP and shouldn’t receive a MIPS payment adjustment. The review window is open for about 60 days, beginning with the release of final scores…
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2024 MIPS Performance Feedback and Final Scores

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The Centers for Medicare & Medicare Services (CMS) has released Merit-based Incentive Payment System (MIPS) performance feedback and final scores for the 2024 reporting year. How Do I Access Feedback? Need access? If you don’t have a HARP account or QPP role, follow the instructions in the QPP Access User Guide (ZIP, 4MB) to get started. Medicare Shared Savings Program Accountable Care Organizations (ACOs) Medicare Shared Savings Program ACOs should assign at least one individual as a…
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Cigna New Reimbursement Policy for Professional Evaluation and Management Services Claims effective October 1, 2025

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Cigna Healthcare will implement a new reimbursement policy, Evaluation and Management Coding Accuracy (R49), to review professional claims billed with Current Procedural Terminology (CPT) evaluation and management (E/M) codes for billing and coding accuracy in alignment with the American Medical Association (AMA) E/M services guidelines. Effective for dates of service on or after October 1, 2025, services may be adjusted by one level to reflect the appropriate reimbursement when the AMA guidelines are not met. What…
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