Saturday, June 20, 2026

A new analysis spotlights high denial rates for rehabilitation and post-acute care by Medicare Advantage plans. This follows HHS OIG reports from earlier this month, which found plans erected barriers to skilled nursing and rehab care. The persistent scrutiny signals intensified federal oversight and audit focus on MA plan medical necessity determinations. This reporting adds public pressure on payers to justify denial rates that exceed original Medicare benchmarks. Billing teams should monitor appeals volumes for post-acute claims and ensure clinical documentation clearly supports the medical necessity of ordered therapy and facility care to withstand payer review.

Complex Rehab Technology (CRT) providers are navigating repair rules and clarifying which services are exempt from prior authorization. This operational guidance is critical for DME suppliers and the practices that prescribe wheelchairs and other adaptive equipment. Misunderstanding the prior auth exemption can lead to claim denials and patient access delays for essential repairs. Billing teams supporting DME or CRT should verify current payer policies for repair codes versus replacement codes. The lack of a universal standard means checking each major payer's DME manual for the 2026 policy year.

The United States has launched a trade investigation targeting Germany's drug pricing policies, escalating a transatlantic dispute. The probe, announced by the U.S. Trade Representative, examines whether Germany's plans to lower drug payments constitute an unfair burden on U.S. pharmaceutical research and development. Germany has warned the move could jeopardize a recent trade truce. This investigation reflects the Biden administration's broader strategy to scrutinize foreign pricing systems it believes disadvantage American innovation, and could influence future domestic drug pricing debates.

HHS has finalized a 2.48% average payment increase for Medicare Advantage plans for 2027. The rate, slightly higher than the initial proposal, reflects the administration's policy priorities for the program. This update provides MA insurers with their reimbursement trajectory for the coming year, influencing plan benefit design and premium setting. The final rate is a key input for the MA industry's financial planning and will shape the offerings available to beneficiaries during the 2027 Annual Election Period.