Tuesday, June 16, 2026

Fairview Health will terminate its UnitedHealthcare Medicare Advantage contracts, affecting patients in its Minnesota network. The move signals escalating strain between large providers and MA payers over payment rates and administrative burden. For practices, this means eligible patients may need to switch plans during the next enrollment period or seek in-network care elsewhere. Monitor UHC's member communications for the effective date and prepare front-office staff to answer patient questions about in-network options.

CMS has issued a final rule, effective 60 days after publication, to bolster oversight of Medicare Accrediting Organizations (AOs) and prevent conflicts of interest. The rule mandates stricter AO transparency, requires CMS approval for AO ownership changes, and prohibits AOs from providing consulting services to organizations they accredit. This aims to tighten survey and enforcement consistency for hospitals and other Medicare-participating facilities. While the direct impact is on facilities' accreditation processes, it signals CMS's continued focus on program integrity and may lead to more rigorous survey activity.

A set of new and revised CPT codes for obstetric care, effective January 1, 2027, will reshape OB-GYN reimbursement. The updates aim to better reflect resource use for complex pregnancies, postpartum care, and managing comorbidities like hypertension or diabetes during gestation. Practices must audit their current coding patterns against the new code set, update their charge masters, and brief clinicians on documentation requirements well before the 2027 implementation. Contact your MAC or payer representative for educational resources and fee schedule impacts as they become available later this year.

A federal judge vacated most of a controversial 2025 CMS rule governing ACA marketplace enrollment and eligibility. The rule, which imposed stricter verification requirements and limited special enrollment periods, was challenged by patient advocacy groups. The court found CMS overstepped its authority. The ruling reverts marketplace operations to pre-2025 standards, potentially easing enrollment barriers for patients seeking coverage through Healthcare.gov and state-based exchanges. For practices that assist patients with ACA enrollment, this reduces administrative hurdles. Monitor CMS for any emergency rulemaking or guidance on how it will implement the court's order ahead of the 2027 open enrollment season.