Tag intelligence

Medicare reimbursement alerts

Reimbursement alerts filtered by specialty and region tags for faster analysis across coding, compliance, and revenue integrity.

Elevated tag risk

Overview

26 alerts match the tag Medicare. Review high-value policy alerts and the underlying claims guidance that matters.

Quick stats

Alert count

26

Distinct policy codes

26

Average signal score

64

Related codes

Signal breakdown

26 shown · 26 total in platform

Risk: Elevated
0

Critical

0%

17

High

65%

9

Routine

35%

0

Low

0%

New this month

+26

alerts added in last 30 days

Effective soon

no upcoming deadlines

Federal Register Notice: Agency Information Collection Activities: Submission for OMB Review; Comment Request

Policy FR-2026-08421Medicare Advantage

High

The CMS is seeking public comment on information collection activities that may influence Medicare billing and reimbursement processes. Stakeholder feedback could lead to changes that impact billing p

Federal Register Notice: Agency Information Collection Activities: Submission for OMB Review; Comment Request

Policy FR-2025-09813Medicare Advantage

High

The proposed information collection by CMS is crucial for evaluating the efficiency and effectiveness of various Medicare services. This initiative might impact billing practices as the agency gathers

Federal Register Notice: Medicare Program; Request for Information on Medicare Advantage Data

Policy FR-2024-01832Medicare Advantage

High

The request for information on Medicare Advantage data aims to enhance CMS's data capabilities, which could lead to changes in billing practices and reimbursement rates for Medicare Advantage plans. I

Federal Register Final Rule: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (PACE)-Finalization of Format Provider Directories for Medicare Plan Finder

Policy FR-2025-18236Medicare Advantage

High

The finalized changes to Medicare Advantage provider directories may impact billing by improving transparency in provider availability, which could lead to better patient access and, potentially, incr

Federal Register Final Rule: Medicare and Medicaid Programs; Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Program of All-Inclusive Care for the Elderly (PACE), Medicaid Fee-For-Service, and Medicaid Managed Care Programs for Years 2020 and 2021

Policy FR-2023-01942Medicare Advantage

High

The recent rule aims to enhance the integrity and accuracy of payments in the Medicare Advantage program by outlining a revised audit methodology for the Risk Adjustment Data Validation (RADV). By cod

Federal Register Proposed Rule: Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability Standards and Prior Authorization for Drugs for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, and Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges

Policy FR-2026-07205Medicare Advantage

Routine

The proposed rule aims to enhance the electronic exchange of health care data and streamline prior authorization processes, which can significantly improve billing efficiency for Medicare Advantage or

Federal Register Final Rule: Medicare Program; Contract Year 2027 and Certain Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program

Policy FR-2026-06600Medicare Advantage

High

The recent rule changes for Medicare Advantage are expected to enhance the overall efficiency of billing and reimbursement processes, particularly in star ratings and drug coverage, which could impact

Federal Register Proposed Rule: Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program

Policy FR-2026-02769Medicare Advantage

Routine

The proposed rule is affecting payment parameters and risk adjustment mechanisms within the Patient Protection and Affordable Care Act. These changes may influence reimbursement rates and complia

Federal Register Proposed Rule: Guarding U.S. Medicare Against Rising Drug Costs (GUARD) Model

Policy FR-2025-23705Medicare Advantage

Routine

The GUARD Model aims to reassess the payment method for Part D drug inflation rebates, potentially impacting reimbursement rates and overall drug costs for Medicare enrollees. By exploring alternative

Federal Register Proposed Rule: Global Benchmark for Efficient Drug Pricing (GLOBE) Model

Policy FR-2025-23702Medicare Advantage

Routine

The proposed GLOBE model aims to introduce a new payment structure for Part B drugs, potentially lowering costs for Medicare FFS beneficiaries and the program overall. This shift may impact reimbursem

Federal Register Proposed Rule: Medicare Program; Contract Year 2027 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program

Policy FR-2025-21456Medicare Advantage

Routine

The proposed rule introduces significant changes to the Medicare Advantage program, aiming to enhance the overall patient experience and streamline processes. These changes could potentially impact bi

Federal Register Final Rule: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly

Policy FR-2025-06008Medicare Advantage

High

The new final rule introduces significant changes to the Medicare Advantage and drug benefit programs which will affect both billing and reimbursement processes. Providers must be aware of updates reg

Federal Register Notice: Agency Information Collection Activities: Proposed Collection; Comment Request

Policy FR-2025-05089Medicare Advantage

Routine

The proposed information collection by CMS aims to enhance the efficiency and transparency of the billing and reimbursement process. By allowing public comments, it seeks to refine data collection pra

Federal Register Proposed Rule: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly

Policy FR-2024-27939Medicare Advantage

Routine

The proposed rule for the Medicare Advantage program introduces significant changes that could impact billing and reimbursement processes. Changes to Star Ratings and drug coverage may influence provi

Federal Register Final Rule: Medicare Program; Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Program for Contract Year 2024-Remaining Provisions and Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (PACE)

Policy FR-2024-07105Medicare Advantage

High

The changes to the Medicare Advantage and Prescription Drug Benefit programs are expected to supports compliance with updated rates processes and improve care coordination. These updates focus on Star Ratings and heal

Federal Register Notice: Agency Information Collection Activities: Submission for OMB Review; Comment Request

Policy FR-2024-06439Medicare Advantage

High

The announcement encourages public comments on CMS's information collection plans, which may impact billing practices by affecting data collection requirements. This could influence how providers subm

Federal Register Final Rule: Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges, Merit-Based Incentive Payment System (MIPS) Eligible Clinicians, and Eligi

Policy FR-2024-00895Medicare Advantage

High

The upcoming final rule aims to enhance the electronic exchange of healthcare data and streamline prior authorization processes, which is expected to improve efficiency in billing practices. These cha

Federal Register Proposed Rule: Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2025; Updating Section 1332 Waiver Public Notice Procedures; Medicaid; Consumer Operated and Oriented Plan (CO-OP) Program; and Basic Health Program

Policy FR-2023-25576Medicare Advantage

Routine

The proposed rule outlines critical updates to payment parameters for 2025, impacting reimbursement structures for Qualified Health Plans. These changes could affect billing practices and coding due t

Federal Register Proposed Rule: Medicare Program; Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Health Information Technology Standards and Implementation Specifications

Policy FR-2023-24118Medicare Advantage

Routine

The proposed rule for Contract Year 2025 introduces significant changes to Medicare Advantage and prescription drug programs, which could impact billing and reimbursement processes. Adjustments in are

Federal Register Final Rule: Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly

Policy FR-2023-07115Medicare Advantage

High

The recent updates to the Medicare Advantage program impact billing and reimbursement by enhancing the focus on health equity, prior authorization processes, and network adequacy, which may affect cla

Medical Devices; Hematology and Pathology Devices; Classification of the Von Willebrand Factor Assay

Policy 2026-10898Medicare Advantage

High

The Food and Drug Administration (FDA) is classifying the von Willebrand factor assay into class II (special controls). The special controls that apply to the d

Medicaid Program; Medicaid Managed Care State Directed Payments and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments

Policy 2026-10292Medicare Advantage

High

This proposed rule describes alternatives to modify the limit on the total payment rate and other requirements for State directed payments in Medicaid managed c

Managed Care

Policy 2026-03779Medicare Advantage

High

Managed Care

Medicare Program; Contract Year 2027 and Certain Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program

Policy 2026-06600Medicare Advantage

High

This final rule revises the Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), and Medicare cost plan regulations to implement changes re

Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability Standards and Prior Authorization for Drugs for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, and Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges

Policy 2026-07205Medicare Advantage

High

These proposals are intended to improve the electronic exchange of health care data and streamline processes related to prior authorization by increasing the in

Request for Information (RFI) Related to Comprehensive Regulations To Uncover Suspicious Healthcare (CRUSH)

Policy 2026-03968Medicare Advantage

High

This request for information (RFI) solicits stakeholder feedback on potential regulatory changes that might be included in a potential upcoming CRUSH proposed r