Saturday, May 16, 2026

CMS announced a nationwide temporary moratorium on the enrollment of new hospices into Medicare, Medicaid, and CHIP, effective immediately. The agency cites a significant risk of fraud, waste, and abuse in these service areas as the justification. The freeze lasts six months, meaning no new applications for provider numbers in these categories will be accepted. This follows a parallel moratorium on new Home Health Agency enrollments announced the same day. For existing practices referring to these services, monitor the enrollment status of your referral partners. The suspension is a fraud-control action under the ACA's temporary moratoria authority and is a clear signal of intensifying CMS audit focus on post-acute care.

Medicare's new rule requiring Medicare Advantage plans to issue prior authorization decisions within 72 hours is now in effect. This applies to both approvals and denials. The mandate aims to reduce delays in care for seniors. For billing teams, this means tracking turnaround times for Medicare Advantage PA requests. Document any delays that exceed 72 hours. This rule, part of the 2025 Medicare Advantage and Part D final rule, includes a 24-hour clock for expedited requests. Monitor payer portals and communications for updates on this policy. If a plan fails to meet the deadline, escalate internally and with the plan's provider relations department. This change directly impacts workflow for scheduling and patient access.

The FY 2027 Inpatient Prospective Payment System proposed rule includes significant changes for hospital coding, clinical documentation improvement, and reimbursement. Key areas of focus include updates to MS-DRG logic, new technology add-on payments, and potential adjustments to the wage index. For practices with hospital outpatient or inpatient services, this rule sets the financial landscape for the coming fiscal year. The proposed rule will have a 60-day comment period. Review the specifics related to your service lines, particularly any proposed changes to CC/MCC designation or new technology codes that could affect your top DRGs. Monitor the Federal Register for the final rule publication later this year.

CMS has adopted a new policy for temporarily withholding federal Medicaid matching funds from states when potential fraud is suspected, rather than waiting for a final determination. This shift aims to act faster against fraudulent spending but could create cash-flow uncertainty for state Medicaid programs and, by extension, providers. The policy represents a more aggressive posture from federal regulators following high-profile fraud cases. While directly targeting state agencies, the financial pressure may indirectly affect provider payment timeliness in implicated states. This is part of a broader CMS anti-fraud initiative that includes the recent nationwide enrollment moratoria for hospices and HHAs.