multi-specialty reimbursement alerts

The CMS has issued a transmittal R13804DEMO updating the GUIDE Model Appendices, which will be effective starting July 6, 2026. Billing teams should review and prepare for any changes detailed in the

This notice announces CMS's intention to collect information from the public, providing an opportunity for comment. The potential impact on billing and reimbursement remains indirect, as the focus is

This RFI seeks input on pharmacy benefit managers (PBMs) and potential restrictions on their compensation related to covered Part D drugs, which may affect future reimbursement practices in Medicare P

The recent approval of Dextrose (Dextrose Monohydrate) as an injectable drug indicates it will be billed under Medicare Part B, likely with an assigned J-code. The billing teams should monitor for the

The new injectable formulation of Dextrose Monohydrate may receive a specific J-code assignment for billing under Medicare Part B. Since it is an injectable drug, it might also qualify for pass-throug

New Medicare Secondary Payer (MSP) error codes will be implemented to enhance the identification of incoming MSP cases. Billing teams need to review and update their systems to accommodate these new c

The October 2026 update for the ICD-10 codes will go into effect on October 5, 2026. Billing teams should prepare to incorporate these new codes into their billing practices as they will impact claims

This transmittal informs billing teams of updates to several sections of the Internet-Only Manual (IOM) Publication 100-04. Teams should review the impacted sections to ensure compliance and update th

This proposed rule aims to implement the Medicare Drug Price Negotiation Program, which will likely influence drug pricing and reimbursement processes under Medicare. Additionally, it plans to modify

The final rule strengthens oversight of Medicare accrediting organizations, which could impact the reimbursement process indirectly by ensuring more consistent standards and reducing conflicts of inte

This notice from CMS is a public opportunity for comment related to information collection under the Paperwork Reduction Act, which may indirectly influence billing processes by defining the quality a

The revisions to the State Operations Manual (SOM), Chapter 5, may impact billing practices for facilities by requiring updated compliance procedures. Billing teams are advised to review their operati

The transmittal updates the process for submitting copybook files to the Fiscal Intermediary Shared System, impacting claims submission protocols. Billing teams should prepare for the implementation o

The recent CMS transmittal updates the Internet Only Manual regarding overpayments, specifically addressing Section 140. Billing teams should review the overpayment protocols and ensure their procedur

This transmittal outlines the new manual update process for Medicare beneficiaries' dates of death, effective July 13, 2026. Billing teams need to ensure that accurate death dates are used in claims s

The establishment of the Office of Health Technology and Products (OHTP) at CMS aims to enhance healthcare technology modernization and digital services pertaining to Medicare and Medicaid programs. T

Billing teams need to review the updates to Chapters 3 and 4 of Pub. 100-08, which will impact various billing processes. Make sure to implement the changes by the effective date of February 26, 2026,

The approval of COLA as an accreditation organization may indirectly influence laboratory billing practices, especially for services related to histocompatibility testing. As COLA gains this deeming a

CMS is seeking public comments regarding its proposed information collection activities, which may influence administrative reporting requirements but do not directly impact billing or reimbursement p

This notice pertains to CMS's intention to collect information under the Paperwork Reduction Act. While it does not directly impact billing or reimbursement, it does open a window for public commentar

This notice from CMS indicates the intention to collect information from the public under the Paperwork Reduction Act. While there is no direct billing impact, the notice suggests that stakeholders ca

Children's Allegra Allergy (fexofenadine hydrochloride) is an oral medication that falls under Medicare Part D coverage. As it is a new dosage form, billing teams should ensure they are familiar with

The CMS Medicare Coverage Database page is currently experiencing technical issues, preventing access to its content. This may impact providers who rely on the database for billing, coding, and covera

The CMS MAC Archives page indicates various updates and changes regarding Medicare billing, reporting, and coding practices. Stakeholders need to review updated guidelines and requirements concerning

The CMS Medicare Coverage Database page is currently malfunctioning due to JavaScript issues, preventing access to certain functionalities. As a result, providers might experience difficulties in retr

The CMS MAC Archives page provides a comprehensive overview of various Medicare policies and updates related to coding and billing. There are mentions of coverage determinations and regulations affect

New FDA approval: AFINITOR DISPERZ (EVEROLIMUS) by Novartis Pharmaceuticals Corporation. Oral — likely Part D.

New FDA approval: OZEMPIC (SEMAGLUTIDE) by Novo Nordisk Pharmaceutical Industries, LP. Injectable — likely Part B J-code.

New FDA approval: AFINITOR (EVEROLIMUS) by Novartis Pharmaceuticals Corporation. Oral — likely Part D.

New FDA approval: SAXENDA (LIRAGLUTIDE) by Novo Nordisk. Injectable — likely Part B J-code.

The billing pathway for Tiocystin (Tiopronin) will follow Part D due to its oral route of administration as a tablet. This means it will likely be reimbursed under the outpatient prescription drug ben

New FDA approval: FUROSEMIDE (FUROSEMIDE) by Marlex Pharmaceuticals, Inc. Oral — likely Part D.

New FDA approval: BRENZAVVY (BEXAGLIFLOZIN) by TheracosBio, LLC. Oral — likely Part D.

New FDA approval: FARXIGA (DAPAGLIFLOZIN) by AstraZeneca Pharmaceuticals LP. Oral — likely Part D.

New FDA approval: STEGLUJAN (ERTUGLIFLOZIN AND SITAGLIPTIN) by Merck Sharp & Dohme LLC. Oral — likely Part D.

New FDA approval: STEGLATRO (ERTUGLIFLOZIN) by Merck Sharp & Dohme LLC. Oral — likely Part D.

New FDA approval: QTERN (DAPAGLIFLOZIN) by ASTRAZENECA AB. Oral — likely Part D.

New FDA approval: INVOKANA (CANAGLIFLOZIN) by Janssen Pharmaceuticals, Inc. Oral — likely Part D.

Updates to the Internet Only Manual (IOM) Publication …

National Fee Schedule for Vaccine Administration Quarterly Update - January 2026

Quarterly Update to Home Health (HH) Grouper

Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP)…

Cardiac Contractility Modulation (CCM) for Heart Failure (HF)

Cardiac Contractility Modulation (CCM) for Heart Failure (HF)

Calendar Year 2026 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (…

April 2026 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions…

January 2026 Annual Rural Emergency Hospital (REH) Monthly Facility Payment Amount

Editing for Hospital Services Provided to Hospice Enrollees

Editing for Duplicate Processing for Practitioner Professional…

Update to the Internet Only Manual (IOM) for Inpatient Billing of Chimeric Antigen Receptor (CAR…