17+ hour, 17+ min ago   (260+ words) Washington policymakers are increasingly aligned around expanding Medicare "site-neutral" payment policies in 2026, a shift that would pay hospital outpatient departments the same rates as physician offices for a broader set of common services. In November, CMS finalized a policy to…...

3+ day, 1+ hour ago   (249+ words) The US Court of Appeals for the Fifth Circuit on December 9, 2025 reversed and remanded a decision from the US District Court for the Northern District of Texas that had vacated a 2023 federal regulation that threatened to reduce supplemental payments for…...

6+ day, 3+ hour ago   (209+ words) Unlike many other CMS Innovation Center models, the ACCESS Model will use voluntary, prospective alignment'meaning that patients with "Original" or fee-for-service ("FFS") Medicare will be able to choose to enroll in the Model directly through an ACCESS Participant or be…...

6+ day, 3+ hour ago   (896+ words) The Landscape for Medicare Advantage (MA) quality, as we know is ever evolving, particularly in light of the just released Contract Year (CY) 2027 Proposed Rule. The proposal, as currently written, proposes major changes to Star Ratings and the ongoing integration…...

1+ week, 2+ hour ago   (231+ words) The Make America Healthy Again: Enhancing Lifestyle and Evaluating Value'Based Approaches Through Evidence (MAHA ELEVATE) Model is a new federal initiative focused on expanding access to preventive and lifestyle-based care options within Original Medicare. The prevalence of chronic disease in…...

1+ week, 1+ day ago   (135+ words) The final Medicare Physician Fee Schedule for 2026 has now taken effect. Under the new rule, Center for Medicare Services (CMS) finalized two separate Medicare conversion factors depending on participation in a qualifying Alternative Payment Model (APM)....By: Tucker Arensberg, P.C. 2026 Medicare…...

1+ week, 1+ day ago   (390+ words) This post focuses on what plan sponsors should do now to prepare their HIPAA NPPs for February 2026what to add, revise, and remove. Since fully insured group health plans are not subject to the requirements discussed in this post, references to…...

1+ week, 2+ day ago   (75+ words) For years, the government has been touting the importance of healthcare organizations having an "effective" healthcare compliance program. The U.S. Department of Justice (DOJ) has issued a 25-page document on what it expects to see when prosecutors evaluate the effectiveness of…...

1+ week, 3+ day ago   (71+ words) This summary highlights recent 2025 Health Insurance Portability and Accountability Act (HIPAA) enforcement actions by the U.S. Department of Health and Human Services' (HHS) Office for Civil Rights (OCR), the risks they underscore for health care organizations and business associates, and practical…...

2+ week, 2+ day ago   (426+ words) Why the 855 Form Deserves Your Attention While the 855 form may seem like an administrative chore, it is the gateway to Medicare reimbursement. Mistakes or delays in updating your enrollment record can lead to a stay or enrollment, deactivation, or other…...