Thursday, May 28, 2026

UnitedHealthcare has issued a new national policy reducing reimbursement for anesthesia services across multiple surgical specialties. The change specifically targets modifiers 59 (distinct procedural service) and 25 (significant, separately identifiable evaluation and management service) appended to anesthesia claims. The policy is effective immediately for new claims; UHC will apply it to existing contracts upon renewal. Billing teams should audit anesthesia claims with these modifiers and prepare for increased denials and appeals volume. Contact UHC provider services for specialty-specific implementation details.

CMS is intensifying efforts to complete Medicaid provider revalidation, a process required every five years to verify enrollment information. The agency is mandating that state Medicaid programs establish and enforce deadlines for providers to submit required documentation. Practices that fail to complete revalidation by their state's deadline risk suspension or termination from Medicaid. This push follows increased scrutiny of program integrity and aims to ensure only qualified, properly credentialed providers participate. Medicaid practices should immediately check their state's Medicaid portal for revalidation deadlines and required documents. Update your enrollment records now to avoid service disruption.

Blue Cross Blue Shield of Michigan and Michigan Medicine have concluded contract negotiations, securing in-network status for the University of Michigan health system. The multi-year agreement replaces a contract that was set to expire, averting potential disruption for thousands of patients. Specific reimbursement rates and policy changes were not disclosed. BCBS Michigan is the state's largest commercial payer. Practices with patients who use Michigan Medicine facilities should confirm the effective date of the new terms and monitor for any referral or authorization changes tied to the updated network configuration.

Five Wisconsin hospitals are at immediate risk of closure following recent federal Medicaid funding reductions. The cuts, part of broader Trump administration Medicaid policy changes, disproportionately affect rural and safety-net facilities already operating on thin margins. Hospital administrators warn that closures would eliminate emergency services, maternity care, and primary care access for thousands of patients, forcing them to travel farther for care. This follows similar warnings from rural hospitals in Colorado and Missouri about inadequate federal grant funding to offset cuts. Monitor state legislative responses and potential federal relief packages as the comment period on Medicaid state-directed payment caps continues through mid-June 2026.

Federal prosecutors have charged multiple individuals and companies in a $522 million genetic testing fraud scheme that billed Medicare and Medicaid for unnecessary or non-existent tests. The investigation alleges the operation used aggressive telemarketing and kickbacks to recruit beneficiaries. The Department of Justice and HHS Office of Inspector General are increasing scrutiny on genetic testing claims, particularly those driven by patient solicitation. This signals a broader enforcement wave targeting high-cost diagnostic services. Billing teams should ensure genetic testing orders are medically necessary, properly documented, and not initiated by marketing entities to avoid audit risk.