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08/11/2025
The struggle against prior authorization in Medicare Advantage has raged for years, but a new wave of voluntary self-reforms by payers suggests that patient, payer and government pressure may be forcing some reforms.
08/11/2025
The Affordable Care Act authorizes the U.S. Preventive Services Task Force to make recommendations that result in no-cost preventive services coverage for beneficiaries of Medicare and other plans. But conflict between the Task Force and HHS Secretary Robert F. Kennedy Jr. may disrupt that process.
08/11/2025
Payments for services during the global surgery period remain a hot-button issue and the data collection program CMS implemented in 2017 is back in the spotlight, thanks to a July 1 report by the HHS Office of Inspector General. The OIG spelled out its conclusions in the July 1 report titled “CMS Should Improve Its Methodology for Collecting Medicare Postoperative Visit Data on Global Surgeries.”
08/11/2025
CMS has big plans for your Part B payments in 2026. For example, it wants to restructure reimbursement to favor services performed in non-facility settings, such as the office, and slash payments for services performed in the facility setting.
08/04/2025
Give your team an early look at new services that you’ll find in the 2026 CPT manual, and that CMS plans to cover in the coming year. The July 28 issue covered E/M, musculoskeletal and cardiovascular codes, among others. Look below for more additions to the CPT code set.
08/04/2025
Look for more counseling services on the list of telehealth-approved codes that Medicare covers. However, note that the new telemedicine codes did not make the grade.
08/04/2025
Prepare for 21 code revisions that you’ll find in the 2026 CPT manual by reviewing changes in the proposed 2026 Medicare physician fee schedule. If you report codes based on out-of-date descriptors, you may quickly amass improper payments and denials or miss out on new revenue opportunities.
08/04/2025
In a series of media appearances in May, the new director of the Center for Medicare and Medicaid Innovation, Abe Sutton, singled out the Medicare Diabetes Prevention Program (MDPP) as a model that “features practical training and education [and] has helped patients meet weight loss goals and lead healthier lives.”
08/04/2025
Discover additional highlights from the proposed 2026 Medicare physician fee schedule, which sets CMS’ regulatory roadmap for the coming calendar year.
08/04/2025
You can welcome a significant pay increase for a wide range of non-facility E/M services, including office visits, critical care, home visits and care management services, should fee proposals from CMS take effect in 2026.

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