Friday, July 17, 2026

A House committee unanimously approved the Medicare Advantage Prior Authorization Reform Act, a bipartisan bill that would standardize and streamline prior authorization processes for MA plans. The bill, which received praise from major healthcare groups, aims to reduce administrative burdens by requiring electronic PA systems, mandating 72-hour decisions for urgent requests, and requiring plans to publicly report denial rates. While passage is not guaranteed, the unanimous committee vote signals strong support. Billing teams should monitor the bill's progress; if enacted, it would change PA workflows with most Medicare Advantage payers starting in 2028.

CMS proposed new G-codes to bundle obstetric services in the 2027 PFS, a shift meant to better reflect modern maternity care. The American College of Obstetricians and Gynecologists expressed concern that the proposed valuation and structure may not adequately cover the full scope of services and could disrupt established billing workflows. If finalized as proposed, OB/GYN practices would need to adopt the new G-codes for Medicare maternity care in January 2027, requiring system updates and staff retraining. ACOG is urging member practices to review the proposal and submit comments by the September 14, 2026 deadline. OB/GYN billing managers should analyze the proposed G-code values against their current service mix now to prepare feedback.

The Department of Homeland Security published a final rule on July 16, 2026, expanding the 'public charge' test to consider immigrants' use of Medicaid, SNAP, and housing assistance when applying for permanent residency. The rule, reinstating and broadening a Trump-era policy, allows immigration officers to deny green cards to applicants deemed likely to depend on these public benefits. This shifts the calculus for millions of immigrant families seeking care, potentially chilling enrollment in Medicaid and other safety-net programs. For practices serving immigrant communities, expect increased patient questions about coverage risks and potentially more uninsured visits as families weigh health access against immigration status.

The Senate Finance Committee continues its probe into Medicare Advantage payment denials, sending follow-up letters to UnitedHealthcare, Humana, and Aetna demanding data on their prior authorization and payment review processes. The inquiry, led by Chairman Ron Wyden (D-OR), follows a 2025 report showing 9-13% denial rates for skilled nursing and home health services in MA plans. The committee is examining whether insurers use algorithms to systematically deny care and whether those denials are later overturned on appeal. The sustained congressional pressure signals potential regulatory action from CMS in 2027, including stricter oversight of MA plan audits and network adequacy.