Saturday, August 8, 2026

CMS has released a proposed rule that would significantly revise the requirements for remote patient monitoring and remote therapeutic monitoring services. The changes would alter the billing parameters for CPT codes 99453, 99454, and 99457, as well as the RTM codes 98980, 98981, and 98982. The proposed overhaul addresses monitoring duration, device supply, and patient consent documentation, aiming to clarify operational gray areas that have led to inconsistent billing practices and audit risks. The comment period for this rule is now open, with a final rule expected by early 2027. Monitor the Federal Register for the official proposal (CMS-2026-XXXXX) and prepare to update RPM/RTM workflows if the changes are finalized.

CMS has published implementation timeline guidance for updates to the No Surprises Act independent dispute resolution process. The guidance outlines the phased rollout of system changes, required payer portal updates, and new data submission requirements for out-of-network payment disputes. The update addresses procedural flaws identified in recent court rulings, including deadlines for payment determinations and documentation standards for qualifying payment amounts. IDR entities and payers must adopt the updated workflow by a specified date in Q4 2026. Billing teams handling out-of-network claims should review the CMS guidance to understand the new dispute windows and documentation checklists.

Nebraska’s Department of Health and Human Services terminated Medicaid coverage for approximately 200 beneficiaries on August 1, 2026, for non-compliance with new work requirements. The state’s implementation follows the federal Medicaid work rule that took effect in late July. Affected individuals lost eligibility for failing to meet monthly work or community engagement hours, or for not submitting required exemption paperwork. Clinics in Nebraska should immediately verify Medicaid eligibility for all patients and prepare for patient inquiries about coverage loss and retroactive denial of claims for services rendered after August 1. Update front-office scripts to direct patients to state resources for reinstatement procedures.

A 2026 KFF update shows continued wide variability in state-funded Medicaid reimbursement rates for abortion services. The patchwork of coverage and payment levels reflects the ongoing political and legal landscape following the Dobbs decision. For practices operating across state lines or serving Medicaid patients, this variability affects both patient access and clinic revenue. It also complicates referrals and continuity of care for patients who may travel out of state. The report underscores that Medicaid billing for reproductive health remains a state-by-state operational challenge with no federal standardization in sight.

Starbucks will stop covering GLP-1 drugs for weight loss, joining a growing list of employers reconsidering coverage as costs surge. Bank of America CEO also noted spending $250 million annually on GLP-1s for staff, calling it a 'good investment' but highlighting the scale of the financial burden. This employer pullback creates a coverage cliff for patients who started therapy under a benefit that may now disappear. For practices, it means more prior authorization appeals, patient conversations about alternative treatments, and potential non-adherence as out-of-pocket costs become prohibitive. Anticipate increased administrative work managing these benefit changes through 2027.