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Federal vs. State AI Rules: What Payers Need to Know

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As states continue introducing prior authorization reforms tied to artificial intelligence, payers are facing growing uncertainty around how AI can be used in claims reviews and medical necessity determinations. A recent KFF analysis outlines several key issues shaping the future of AI regulation in healthcare. As AI adoption expands across healthcare operations, providers and payers may need to monitor both state legislation and emerging federal guidance closely to remain compliant and prepared for future regulatory…
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CMS Launching $50 Monthly GLP-1 Medication Program for Medicare Beneficiaries

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Beginning July 1, 2026, CMS will introduce the Medicare GLP-1 Bridge demonstration program, allowing eligible Medicare Part D beneficiaries to access select GLP-1 medications for a capped cost of $50 per month through the end of 2027. The initiative is designed to improve affordability and access to GLP-1 therapies, which are increasingly used to support weight management and related chronic health conditions but often remain financially out of reach for many seniors. CMS says the…
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CY 2024 Doctors and Clinicians Preview Period Opens May 13

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CMS will open the CY 2024 Doctors and Clinicians Preview Period on May 13, 2026, giving providers an opportunity to review their Quality Payment Program (QPP) performance information before it becomes publicly available on Medicare.gov and the Provider Data Catalog. During the preview period, clinicians and groups can securely access and review their reported performance data through the QPP website to verify accuracy and prepare for upcoming public reporting. This early review period is an…
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2026 QPP Exception Applications Now Open

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The 2026 Quality Payment Program (QPP) exception applications are officially available through December 31, 2026, giving eligible clinicians, groups, virtual groups, and APM participants an opportunity to request relief from certain Merit-based Incentive Payment System (MIPS) reporting requirements when circumstances prevent successful participation. This year’s applications include two primary exception pathways: the Promoting Interoperability Hardship Exception and the Extreme and Uncontrollable Circumstances (EUC) Exception. These options are designed to support providers facing challenges such as…
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Medicare Advantage Tensions Escalate: Why Health Systems Are Walking Away in 2026

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Hospitals and health systems are increasingly ending contracts with certain Medicare Advantage (MA) plans in 2026, reflecting growing strain between providers and insurers. As MA enrollment continues to rise—now covering more than half of Medicare beneficiaries—these decisions carry significant implications for patient access and continuity of care. At the center of this trend are ongoing operational challenges. Many providers report that prior authorization requirements frequently delay or deny medically necessary services, creating care disruptions and…
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Rural Emergency Hospitals on the Rise: What the Latest CMS Data Means

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Since Centers for Medicare & Medicaid Services introduced the Rural Emergency Hospital (REH) designation in January 2023, 50 hospitals across 21 states have transitioned to this model, signaling a major shift in how rural healthcare is delivered and sustained. The REH designation is designed to help struggling rural hospitals remain operational by focusing on emergency and outpatient services, rather than maintaining full inpatient care. This allows facilities to continue serving their communities while stabilizing financially—an…
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Understanding Denial Code PR 27: What It Means and How to Handle It

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Denial Code PR 27 indicates that a claim has been denied because the patient’s insurance coverage was no longer active on the date services were provided, making the balance the patient’s responsibility. While this may seem straightforward, it can create ripple effects across your revenue cycle—from delayed payments and increased administrative work to patient dissatisfaction if not handled proactively. These denials most commonly stem from lapsed coverage, outdated eligibility information, or missed verification of policy…
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Understanding Denial Code PR 27: What It Means & How to Prevent It

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Denial Code PR 27 signals that a claim has been denied because the patient’s insurance coverage was no longer active on the date of service, making the balance the patient’s responsibility and a potential risk to your revenue cycle. This denial most often stems from issues like lapsed coverage, outdated eligibility information, or missed verification of coverage end dates prior to treatment. In some cases, coordination of benefits changes or system errors can also trigger…
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CMS Open Payments Review Period Now Open for 2025 Data

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Centers for Medicare & Medicaid Services has opened the review period for Program Year 2025 Open Payments data, giving covered recipients an opportunity to verify submitted information before it becomes public in June. Reporting entities submitted data between February 1 and March 31, and providers are now encouraged to review records for accuracy. While participation is voluntary, reviewing this data is critical to ensuring that any reported financial relationships are accurate and properly represented. The…
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UnitedHealthcare Expands Rural Initiatives, Reduces Prior Authorizations

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UnitedHealthcare is scaling its rural healthcare initiatives nationwide, introducing faster payment timelines and easing administrative requirements for hospitals and providers in underserved areas. A key component of the expansion includes accelerating reimbursements—cutting payment timelines by up to 50%—for approximately 1,500 hospitals, including all critical access hospitals. Early results from its Rural Payment Acceleration Pilot show Medicare Advantage payments reaching hospitals in under 15 days on average, a significant improvement from traditional timelines. The program, initially…
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Community Health Systems Expands ASC Footprint Across Key Markets

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Community Health Systems is continuing to grow its ambulatory surgery center (ASC) network in 2026 through a combination of acquisitions and new facility development, reinforcing the broader industry shift toward outpatient care delivery. The system recently opened new ASCs in Alabama—including Birmingham and Foley—and expanded into Alaska with the acquisition of a majority stake in a surgery center in Anchorage, bringing its total to 36 affiliated ASCs. An additional acquisition of Surgical Institute of Alabama…
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Flu Activity Declines Nationwide, Pediatric Risk Remains Elevated

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Flu activity across the U.S. continues to trend downward, with cases and hospitalizations declining for the ninth consecutive week, according to the Centers for Disease Control and Prevention. The 2025–2026 flu season is currently classified as moderate in severity for the general population, signaling overall improvement as the season progresses. However, risk remains significantly higher for pediatric populations. The season is still considered high-severity for children, with recent reported deaths bringing the total to 143—well…
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