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Medicare’s rules for prior authorization requests (PAR) for certain procedures performed in the hospital outpatient department (HOPD) are designed to prevent abusive utilization and billing. The Dec. 8 issue of Part B News reveals a skyrocketing rate of prior authorization requests.
 
 
CMS will expedite the next National Correct Coding Initiative update to stop denials when a provider reports administration of the COVID-19 vaccine and another vaccine code for the same patient on the same day.
 
The Continuing Appropriations and Extensions Act, 2026 (CAE 2026), reactivated the COVID-19 telehealth waivers until Jan. 30, 2026. Better still, the CAE 2026 closed a potential telehealth payment gap by backdating the extension to Sept. 30, 2025.
 
Your providers will see higher conversion factors (CF) in 2026, with a 3.8% boost to those participating in qualifying alternative payment models (APM) and a 3.3% increase for everyone else. Yet a yawning gap in reimbursement levels will confront practices in 2026, depending on whether your providers deliver care in the non-facility or facility setting.
 
 
Members of Congress did not come to a budget agreement before the Oct. 1 start of the fiscal year, and a government shutdown of all but "essential" spending is now in effect. CMS has issued some advice to providers.
 

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