CMS just announced a nationwide six-month moratorium on new DMEPOS enrollments and changes in majority ownership, along with new transparency measures and expanded fraud prevention efforts under its CRUSH initiative. This is not just another enforcement update; it’s a signal of where program integrity is heading in 2026 and beyond.
The 2025 Medicare Fee-For-Service Improper Payments Report was just released. The report identified an estimated $28.8 billion in improper payments with a payment error rate of 6.55%, slightly down from last year. The report outlines findings related to services most frequently billed and paid in error and outlines the reasons for the
Effective January 1, 2026, CMS finalized a major shift in how skin substitute products are paid under the OPPS, ASC, and non-facility settings, with coding, compliance, and financial implications. The new rules are designed to reduce cost and overutilization of expensive products. Under the new, current rules, CMS will: Separately pay
CMS released the CY 2026 OPPS/ASC Final Rule, introducing significant updates to Hospital Price Transparency (HPT) standards that take effect January 1, 2026. These revisions strengthen patient access to clear, comparable pricing information and heighten expectations for operational accuracy, data quality, and regulatory oversight. Compliance, revenue cycle, legal, and operational
CMS has released the CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Final Rule, confirming several major policy shifts while making notable changes to what was originally proposed. OPPS Highlights Finalized as Proposed Continued phase-out of the Inpatient-Only (IPO) list with a multi-year removal process and related Two-Midnight exemptions. This included
The OIG’s recent audit of dermatology providers highlights a critical compliance checkpoint: billing of evaluation & management (E/M) services on the same day as minor surgical procedures. Key Takeaways The audit found that many dermatology claims combined same-day E/M services with minor surgical procedures despite Medicare’s global-surgery and coding rules.
