Wednesday, June 24, 2026

Blue Cross Blue Shield of Michigan has announced it will overhaul its incident-to billing policy and introduce new limits for value-based payment arrangements. The payer plans to implement stricter documentation requirements for services billed under a supervising physician’s NPI when performed by non-physician practitioners like nurse practitioners and physician assistants. Concurrently, BCBS-MI will cap certain incentive payments and shared savings in its value-based contracts, potentially reducing upside revenue for high-performing practices. These changes are slated to go into effect with the payer’s 2027 plan year, meaning practice contracts negotiated this fall will reflect the new terms. Michigan practices billing incident-to or participating in BCBS VBP models must review their 2027 contract proposals and model the financial impact of the new limits. Update your internal billing audits now to ensure incident-to documentation meets the forthcoming standard.

The Centers for Medicare & Medicaid Services' WISeR pilot, an artificial intelligence system designed to automate prior authorization decisions for certain Medicare services, is encountering significant operational problems. Reports indicate the system is generating errors and delays, trapping both patients and providers in administrative limbo. The pilot, which began earlier this year, aims to speed up approvals but is instead causing backlogs and requiring manual intervention from CMS staff. For practices submitting prior auths to Medicare, this means unpredictable turnaround times and potential care delays for beneficiaries. The agency has not announced a pause or fix timeline. While the pilot is limited in scope, its troubles highlight the risks of relying on new automated systems for time-sensitive workflows. Track the status of any WISeR-related authorizations extra closely and have a process to flag delayed cases for manual follow-up with the Medicare Administrative Contractor.

A new HHS report finds Medicare Advantage plans denied prior authorization requests at unusually high rates for post-acute care, including skilled nursing and inpatient rehabilitation. This formalizes earlier investigative reporting and signals increased scrutiny from regulators. The report does not name specific insurers but indicates a systemic issue affecting patient transitions from hospitals to follow-up care. Practices with high post-acute referral volumes should monitor for increased appeals and prepare supporting clinical documentation.

A new survey indicates most large employers are maintaining coverage for GLP-1 obesity drugs like Wegovy and Zepbound in 2026, but many are evaluating restrictions or dropping coverage for 2027 due to high costs. This creates uncertainty for practices managing patients on these medications. The decision timeline means patients may face new prior authorization hurdles or lose coverage in the next plan year. Begin conversations with patients now about potential 2027 coverage changes and document medical necessity rigorously for current auth requests.