The Centers for Medicare & Medicaid Services (CMS) has issued the CY 2026 Medicare PFS Proposed Rule (CMS-1832-P), and it brings major updates to payment policies under Medicare Part B. Here’s what you need to know: Separate Conversion Factors: Beginning in 2026, two conversion factors will apply—one for qualifying alternative
The Centers for Medicare & Medicaid Services (CMS) has issued “Updated Hospital Price Transparency Guidance” (May 22, 2025) which outlines new policies pursuant to Executive Order 14221, “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information.” CMS aims to ensure hospitals submit accurate, actionable pricing
The Centers for Medicare & Medicaid Services (CMS) has announced a major expansion of its audits of Medicare Advantage (MA) plans. Effective immediately, CMS will audit all eligible MA contracts for each payment year in all new audits and aims to complete audits for 2018–2024 by early 2026. This initiative
The OIG has issued their Semiannual Report to Congress for the period April 1, 2024 through September 30, 2024. The report highlights $7.13 billion in expected investigative and audit recoveries identified during the entirety of FY 2024. The report also details the OIG’s ongoing work through investigations and enforcement actions
The 2024 Medicare Fee-For-Service Improper Payments Report was just released. The report identified an estimated $31.70 billion in improper payments with a payment error rate of 7.66%, up from last year. The report outlines findings related to services most frequently billed and paid in error and outlines the reasons for
The Office of Inspector General (OIG) issued their November Work Plan. The update includes plans to evaluate incident to services to determine whether they complied with Medicare requirements. Improper payments of incident to services continues to be the focus of numerous audits, overpayment and False Claims Act settlements. Incident to
