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The CMS activities that will, won’t continue during the shutdown

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Following the federal government shutdown on October 1, the Centers for Medicare & Medicaid Services (CMS) has released details outlining which activities will continue and which will be paused during the lapse in funding. About 53% of CMS staff—approximately 3,300 employees—will remain active to support essential operations. What Will Continue: What Will Be Paused or Limited: Healthcare providers should be aware of potential delays in communication, policy updates, and certain CMS activities until government funding…
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Pfizer to Reduce U.S. Drug Prices Under New Federal Agreement

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Pfizer has become the first pharmaceutical company to lower the cost of its prescription medications in the U.S. through a new agreement with the federal government. The move aims to make a wide range of medications more affordable for patients and healthcare programs. Key Updates: This marks a major step toward increasing medication affordability and reshaping how prescription drug prices are negotiated in the U.S. Resource: Pfizer to lower US drug prices; White House unveils…
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Measles Cases Rise Across the U.S. in 2025 — Including Alabama

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As of September 30, 2025, the CDC has confirmed 1,544 measles cases across the United States — a significant increase compared to 285 total cases reported in 2024. Alabama is among 42 states and jurisdictions reporting confirmed cases this year. The CDC also notes 42 measles outbreaks so far in 2025, with 86% of all confirmed cases linked to outbreak clusters. This marks a sharp rise from 16 outbreaks reported during the previous year. Healthcare…
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CDC Updates Immunization Schedules: COVID-19 and Chickenpox Guidance

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The Centers for Disease Control and Prevention (CDC) has released updated adult and child immunization schedules, introducing important changes to both COVID-19 and varicella (chickenpox) vaccine recommendations. For COVID-19, the CDC now emphasizes shared clinical decision-making between providers and patients. Instead of a universal recommendation for everyone aged six months and older, clinicians are encouraged to base vaccination decisions on each patient’s individual health status and risk factors. This approach allows providers to guide patients…
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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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