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UnitedHealth Group Updates: Key Developments Healthcare Organizations Should Monitor

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UnitedHealth Group and its subsidiaries have been involved in several notable developments across healthcare, pharmacy benefits, leadership, and regulatory matters. Here are ten updates healthcare organizations may want to monitor: 1. Fairview Health Services to End Certain Medicare Advantage Scheduling Minneapolis-based Fairview Health Services announced it will stop scheduling patients enrolled in UnitedHealthcare Medicare Advantage plans beginning January 1, 2027, signaling ongoing challenges in payer-provider contracting. 2. Optum Rx Appoints New Health Plan Market President…
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Medicare GLP-1 Bridge Program Launches July 1: What Practices and Patients Should Know

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Beginning July 1, Medicare beneficiaries may see significant savings on certain GLP-1 medications through the new Medicare GLP-1 Bridge Program. The initiative was established through agreements with major drug manufacturers and is designed to improve access to popular weight management and diabetes medications while reducing out-of-pocket costs for eligible patients. Several large pharmacy providers are preparing to support the program. CVS Health announced expanded patient services that include lower copay options for qualifying Medicare beneficiaries,…
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QPP Releases 2027 Registry Self-Nomination Resources

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Organizations interested in participating as a Qualified Clinical Data Registry (QCDR) or Qualified Registry for the 2027 Merit-based Incentive Payment System (MIPS) performance year can now access updated self-nomination materials through the Quality Payment Program (QPP) Resource Library. CMS has published several key resources to help organizations prepare for the application process, including a self-nomination fact sheet, a detailed user guide, and a measure development handbook. These materials outline eligibility requirements, application procedures, and expectations…
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Preparing for the New Maternity Care Coding Changes in 2027

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Healthcare providers who offer obstetric services should begin preparing for significant maternity coding updates that take effect January 1, 2027. The American Medical Association (AMA) is retiring the longstanding global obstetric code structure and replacing it with a new maternity care code set designed to better reflect the care patients receive throughout pregnancy. The current global coding model bundles many maternity services together, regardless of differences in patient needs, visit frequency, or pregnancy complexity. The…
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CMS Updates Demographic Data Refresh Schedule and Medicare Claims Lookback Period

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The Centers for Medicare & Medicaid Services (CMS) has implemented changes designed to improve the accuracy and availability of clinician information within the Quality Payment Program (QPP). More Frequent Demographic Data Updates Beginning in April 2026, CMS increased the refresh frequency for Doctors and Clinicians demographic data from every two months to monthly updates. This change allows provider profile information to be updated more regularly, helping ensure that publicly available clinician data remains current and…
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QPP Update: Key MIPS Registration Deadlines, Performance Data, and Compliance Announcements for 2026

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The Centers for Medicare & Medicaid Services (CMS) recently released several important updates affecting Merit-based Incentive Payment System (MIPS) participants, Alternative Payment Model (APM) entities, and healthcare organizations preparing for the 2026 performance year. 2026 MVP Registration Is Now Open Organizations planning to participate in a Merit-based Incentive Payment System (MIPS) Value Pathway (MVP) can now register through November 30, 2026. Before registering, participants should identify: CMS also introduced a new requirement for group reporting…
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CMS Completes Transition to Paperless CLIA Operations

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Laboratories participating in the Clinical Laboratory Improvement Amendments (CLIA) program should be aware that CMS has fully transitioned to paperless operations as of March 1, 2026. This change affects how laboratories receive certificates, pay fees, and receive official communications from CMS. What Has Changed? CMS no longer mails paper CLIA certificates or fee coupons. In addition, all CLIA certification and survey fees must now be paid electronically. Paper checks are no longer accepted. Laboratories can…
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Compliance Update: Dermatology Billing Requirements and the Return of PEPPER Reporting

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Staying ahead of Medicare compliance changes can help healthcare organizations reduce audit risk, improve billing accuracy, and identify potential reimbursement issues before they become larger concerns. Two recent CMS updates highlight areas providers and facilities should review closely. Dermatology Billing: E/M Services and Minor Surgical Procedures CMS is reminding dermatologists and billing staff to ensure Evaluation and Management (E/M) services are billed correctly when performed on the same day as a minor surgical procedure. A…
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Understanding PR 96 Denials: Common Causes and Prevention Strategies

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PR 96 denial codes indicate that a service is considered non-covered under a patient’s insurance plan, making the patient financially responsible for the charge. These denials can occur even on clean claims and often stem from coverage limitations, policy exclusions, or documentation issues. Common causes of PR 96 denials include: To help reduce PR 96 denials, providers are encouraged to strengthen insurance verification processes, obtain prior authorizations when required, improve coding accuracy, and educate both…
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Summer Travel Safety Tips for Heat and Sun Exposure

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With summer travel and outdoor activities increasing, healthcare professionals are encouraging individuals to take extra precautions to protect themselves from heat-related illness and sun exposure. Recommended safety measures include using water-resistant sunscreen with adequate SPF protection, reapplying after swimming or prolonged outdoor activity, and wearing hats and sunglasses to help reduce direct sun exposure and protect eye health. Hydration is also a major focus, particularly for individuals sensitive to heat or bright sunlight. Electrolyte drink…
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CMS Updates: Mental Health, RPM Compliance, ASM Participation & More

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National Mental Health Awareness Month Highlights Preventive Care Access During National Mental Health Awareness Month, Centers for Medicare & Medicaid Services is encouraging providers to prioritize mental health and preventive care services for Medicare patients. CMS emphasized that mental health plays a major role in healthy aging and overall quality of life, while also reminding providers that many Medicare preventive services are available to patients at no cost when assignment is accepted. CMS also highlighted several behavioral…
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CMS Releases Updated eCQM Specifications for 2027 Reporting Period

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Centers for Medicare & Medicaid Services has released updated electronic clinical quality measure (eCQM) specifications and implementation resources for the 2027 reporting and performance period across hospital inpatient, hospital outpatient, and eligible clinician quality reporting programs. The annual updates are designed to keep measures aligned with current clinical guidelines, coding standards, and healthcare reporting requirements. The updated resources include revised eCQM specifications, implementation guidance, technical release notes, telehealth guidance, and measure reference tables available through the…
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