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Reimbursement Intelligence
CMS policy analysis, MAC LCD updates, ICD-10 coding guidance, and revenue cycle news — generated from live federal data and updated daily.
52 policy briefs · 4 upcoming deadlines
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Understanding Interoperability Standards: Prepare for Medicare Advantage Changes by June 15, 2026
What Changed The proposed rule outlined in the Federal Register (Policy ID: FR-2026-07205) aims to enhance the efficiency of billing processes within Medicare Advantage programs by improving the elect
Retroactive — effective Jun 15, 2026
Medicare Advantage 2027: Key Changes to Watch for in Billing Practices
What Changed
Retroactive — effective Jun 1, 2026
Inpatient IPPS: Proposed Changes for FY 2027 Reimbursement Strategies
Review the proposed IPPS changes affecting hospital reimbursement strategies — see policy ID FR-2026-07203 for details.
Master List Update: Key Prior Authorization Changes Affecting Coders by April 2026
What Changed The recent updates to the Medicare Physician Fee Schedule (PFS), effective April 13, 2026, introduce significant modifications to the Master List of items potentially requiring a face-to-
Retroactive — effective Apr 13, 2026
Skilled Nursing Facility Alert: Proposed Payment System Changes — Action Required
Proposed updates to SNF payment system for FY 2027 require immediate attention.
Medicaid Funding Preservation Rule: Key Tax Loophole Closure Effective April 2026
What Changed
Retroactive — effective Apr 3, 2026
Physician Fee Schedule Alert: 2026 PFS Corrections — Review and Update Systems
Critical corrections to 2026 Medicare PFS require billing system updates by providers.
Retroactive — effective Mar 12, 2026
Dialysis Billers: Navigating the 2026 ESRD Payment and Quality Incentive Overhaul
What Changed
Retroactive — effective Jan 1, 2026
PFS 2026: Key Part B Payment Adjustments for January 1 Implementation
What Changed
Retroactive — effective Jan 1, 2026
Hospital Outpatient Alert: Payment System Changes — Action Required by 2026
Significant changes to OPPS and ASC payment systems effective January 1, 2026.
Retroactive — effective Jan 1, 2026
Medicare Part B PFS 2026: Key Revisions Affecting Physician Fee Schedule Billing
What Changed
Retroactive — effective Nov 28, 2025
Medicare Advantage 2026: Provider Directory Format Changes Effective November 17
What Changed The Medicare Advantage payment system will undergo significant changes effective November 17, 2025, as outlined in the Federal Register Final Rule (Policy ID: FR-2025-18236). The updates
Retroactive — effective Nov 17, 2025
FY 2026 SNF PPS Final Rule: Key Billing Updates Effective October 2025
What Changed
Retroactive — effective Oct 1, 2025
Medicare PFS 2026 Proposed Rule: Key Changes and Comment by September 12, 2025
What Changed
Retroactive — effective Sep 12, 2025
Medicare Advantage 2026: Key Changes in Billing and Compliance Effective June 3
What Changed
Retroactive — effective Jun 3, 2025
ESRD Alert: New IOTA Model — Compliance Required by January 2025
The IOTA Model enhances kidney transplant access and requires compliance by January 3, 2025.
Retroactive — effective Jan 3, 2025
ESRD Billing Overhaul: New Payment System and Quality Incentives Effective January 2025
What Changed
Retroactive — effective Jan 1, 2025
Home Health 2025: Key Changes in HH PPS and IVIG Rates Effective January 1
What Changed
Retroactive — effective Jan 1, 2025
Medicaid Alert: Drug Misclassification Changes — Action Required by November 2024
New Medicaid Drug Rebate Program rules effective November 19, 2024, require compliance with stricter drug classification and documentation.
Retroactive — effective Nov 19, 2024
Inpatient Alert: New Appeal Rights for Patient Status Changes — Action by October 2024
New appeal rights for Medicare beneficiaries effective October 10, 2024.
Retroactive — effective Oct 11, 2024
Inpatient Prospective Payment System Updates: Key Changes for FY 2025 Billing Practices
What Changed
Retroactive — effective Oct 1, 2024
Inpatient Psychiatric Alert: Rate Update — Action Required by October 2024
Medicare updates inpatient psychiatric payment rates effective October 1, 2024.
Retroactive — effective Oct 1, 2024
FY 2025 Hospice Wage Index Update: Key Changes for Skilled Nursing Coders
What Changed
Retroactive — effective Oct 1, 2024
Inpatient Alert: Medicare IRF Payment Changes — Action Required by October 2024
New payment rates for Inpatient Rehabilitation Facilities effective October 1, 2024.
Retroactive — effective Oct 1, 2024
FY 2025 SNF PPS Update: Key Billing Changes Effective October 1, 2024
What Changed
Retroactive — effective Oct 1, 2024
Court Decision Alters FY 2025 IPPS Rates: Key Changes for Inpatient Coders
What Changed
Retroactive — effective Sep 30, 2024
Medicaid Access Rule 2024: Key Billing Changes Coders Must Implement by July 9
What Changed The Medicaid Access Rule 2024, effective July 9, 2024, introduces significant changes to the Medicaid payment system, focusing on transparency and accountability. This rule aims to improv
Retroactive — effective Jul 9, 2024
Medicaid Alert: New Managed Care Rule — Action Required by July 2024
New Medicaid managed care rule effective July 9, 2024, requires compliance actions.
Retroactive — effective Jul 9, 2024
Skilled Nursing Facility Alert: New Staffing Standards — Action Required by June 21, 2024
New minimum staffing standards for skilled nursing facilities effective June 21, 2024, require immediate compliance actions.
Retroactive — effective Jun 21, 2024
Decoding 2025 Benefit Parameters: Essential Updates for Multispecialty Coders by June 2024
What Changed The recent update to the Patient Protection and Affordable Care Act's payment parameters, effective June 3, 2024, introduces significant changes to how payments are adjusted and administe
Retroactive — effective Jun 4, 2024
Medicaid Enrollment Process Overhaul: Key Billing Changes Effective June 3, 2024
What Changed
Retroactive — effective Jun 3, 2024
Navigate the 2024 PFS Final Rule: Key Updates for Physician Fee Schedule Coders
What Changed
Retroactive — effective Feb 12, 2024
Understanding the Remedy for 340B-Acquired Drug Payments: Updates for OPPS Coders
What Changed
Retroactive — effective Jan 8, 2024
PFS 2024: Essential Medicare Part B Payment Changes for Coders to Implement
What Changed
Retroactive — effective Jan 1, 2024
Hospital Outpatient Alert: Medicare Payment Changes — Action Required by January 1, 2024
Significant updates to Medicare OPPS and ASC payment systems effective January 1, 2024.
Retroactive — effective Jan 1, 2024
Medicaid and CHIP Core Set Reporting: Essential Updates for Multi-Specialty Coders by January 2024
What Changed
Retroactive — effective Jan 1, 2024
Navigate 2024 Home Health PPS Updates: Key Changes for Medicare Billing Coders
What Changed
Retroactive — effective Jan 1, 2024
Medicaid MSP Enrollment Streamlined: Key Billing Updates Effective November 17
What Changed The Medicare Savings Programs (MSPs) payment system has undergone a significant update with the Federal Register Final Rule (Policy ID: FR-2023-20382), effective November 17, 2023. This u
Retroactive — effective Nov 17, 2023
FY 2024 IRF PPS Final Rule: Key Payment Updates Effective October 1
What Changed
Retroactive — effective Oct 1, 2023
FY 2024 IPF Payment System Update: Key Rate Changes Effective October 1
What Changed
Retroactive — effective Oct 1, 2023
Medicare Hospice Payment Rates Updated for FY 2024: Key Changes for Coders
What Changed
Retroactive — effective Oct 1, 2023
Skilled Nursing Facility Alert: Payment Structure Changes — Action by October 1, 2023
Significant updates to SNF payment structure effective October 1, 2023.
Retroactive — effective Oct 1, 2023
Oncology Alert: Glofitamab Approval — Prepare for Part B Billing Changes
FDA approves Glofitamab; oncology practices should prepare for upcoming billing updates.
Retroactive — effective Jun 15, 2023
FY 2024 SNF PPS Proposed Rule: Comment by June 5 on Billing Updates
What Changed The Skilled Nursing Facility Prospective Payment System (SNF PPS) is undergoing significant updates with the proposed rule for the Federal Fiscal Year 2024, as outlined in the Federal Reg
Retroactive — effective Jun 5, 2023
Medicare Advantage 2024: Key Billing Updates for Contract Year Implementation
What Changed
Retroactive — effective Jun 5, 2023
Physician Fee Schedule Update: Review New Refund Requirements for Compliance
New PFS rules affect billing strategies, effective March 15, 2023.
Retroactive — effective Mar 15, 2023
Oncology Alert: Imfinzi Billing Update — Review Formulary Compliance
New FDA approval for Imfinzi impacts billing practices; update required.
Retroactive — effective May 1, 2017
Oncology Alert: Darzalex J-Code Expected — Prepare for Billing Update
New J-code anticipated for Darzalex; actions needed include formulary updates and reimbursement model adjustments.
Retroactive — effective Nov 16, 2015