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Category: General

UnitedHealthcare Updates Radiology Reimbursement Policy

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Effective April 1, 2026, UnitedHealthcare will update its reimbursement policy for radiology services billed on the same day as evaluation and management (E/M) services. When the same provider bills both an E/M service and a global radiology code for the same patient, a full written interpretation and report will be required to separately reimburse the professional component of the radiology service. Reports must follow American College of Radiology guidelines. If different providers bill the E/M…
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UAB Health System Acquires Southview Medical Group

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On Jan. 1, UAB Health System completed its acquisition of Southview Medical Group in Birmingham, Ala. The multi-specialty practice includes 30 providers, caring for over 51,000 patients annually with more than 130,000 patient visits. Under the agreement, UAB assumed ownership of Southview’s provider network facilities, including UAB St. Vincent’s Birmingham and UAB Medicine St. Vincent’s One Nineteen locations. Patients will continue seeing their trusted providers while gaining access to UAB’s broader network of specialists, advanced…
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Blue Cross and Blue Shield of Alabama Ends Medicare Fitness Benefit

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Blue Cross and Blue Shield of Alabama will discontinue its Medicare fitness benefit effective Jan. 1, 2026. The move follows a transition in 2024 from the SilverSneakers program to a FlexCard fitness allowance, which the insurer said saw low utilization. A spokesperson noted that maintaining the benefit contributed to higher costs that affect all members, and the change allows BCBS to focus on medical services used by the broadest number of members, helping keep premiums…
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Flu Season Starts Early and Strong

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The current flu season is off to an unusually early and severe start, with flu-like outpatient visits reaching levels rarely seen this time of year. As of mid-December, about 4.1% of outpatient visits were for respiratory illness, making it the third-highest rate for this point in the season since 2010, according to CDC data. The CDC estimates there have already been approximately 4.6 million flu cases nationwide, resulting in about 49,000 hospitalizations and 1,900 deaths….
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CMS & QPP Updates Providers Should Know

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2025 QPP Data Submission is Now Open QPP Service Center Hold Times 2026 MIPS Payment Adjustments in Effect Based on 2024 Performance Updates to 2026 PY Eligible Clinicians Electronic Clinical Quality Measures (eCQMs) based on Medicare PFS Final Rule Now Available: Updated Technical Release Notes for the 2026 Performance Period Electronic Clinical Quality Measures (eCQMs) for Eligible Clinicians

CMS Removes Mandatory Vaccine Reporting Measures for Medicaid and CHIP

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CMS has announced that states will no longer be required to report immunization status data for children and pregnant individuals, following a Dec. 30 letter sent to state health officials. Beginning in 2026, CMS removed four vaccine-related reporting measures tied to Medicaid and the Children’s Health Insurance Program (CHIP). This change affects a substantial portion of the population, as Medicaid covers nearly 70 million people and CHIP serves approximately 7 million, limiting the availability of…
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2025 QPP Data Submission Is Now Open

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CMS has officially opened data submission for the 2025 Quality Payment Program (QPP) performance year. Eligible clinicians and practices can submit or update their data through the QPP portal now through March 31, 2026, at 8:00 p.m. ET. During this period, providers can submit their own MIPS data or review data submitted on their behalf by a third party. It’s important to carefully review all reported information before the deadline, as data cannot be corrected…
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Flu Hospitalizations Reach Third-Highest Early-Season Level in 15 Years

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According to the CDC’s latest FluView report, flu hospitalizations are at the third-highest level for this point in the season in 15 years, with a cumulative hospitalization rate of 6.9 per 100,000 for the week ending Dec. 6. Weekly hospitalizations also increased to 2.2 per 100,000, up from 1.7 the week prior. Resource: Flu admissions hit third-highest early-season level in 15 years

CMS Releases New Medicare Data Updates for 2024–2025

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CMS has released several updated datasets and resources providing insights into Medicare beneficiaries, facility performance, and telehealth trends: Medicare Current Beneficiary Survey (MCBS) – 2024 Updates: Cost Report Public Use Files – 2023: Medicare Telehealth Trends – Q1 2025: Medicare Beneficiaries at a Glance – 2023: Medicare Enrollment – August 2025: These updates provide a clear snapshot of Medicare utilization, coverage trends, telehealth adoption, and facility-level performance, making it easier for providers, researchers, and policymakers…
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CMS Shares Key December 2025 Updates for Medicare Providers

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CMS recently highlighted several important updates for providers, including the new MAHA ELEVATE Model, upcoming requirements for the Outpatient Prospective Payment System Drug Acquisition Cost Survey, and guidance to help critical access hospitals avoid claim denials. The update also covers compliance tips, coding and payment changes, upcoming webinars like the PEPPER session, and recent MLN Matters articles. For the full set of updates and resources from CMS’ Medicare Learning Network, see the details here.