Saturday, September 5, 2026

The American Medical Association published a breakdown of the 2027 Medicare Physician Fee Schedule proposed rule, which includes a 2.8% cut to the conversion factor. The rule proposes new valuation and payment policies for remote therapeutic monitoring services, including potential bundling of some codes and a shift in reimbursement methodology. It also updates payment rates and policies for over 1,900 other services. The AMA is urging physicians to analyze the impact on their specialty ahead of the final rule, expected in November 2026. Practices billing for RTM should monitor CMS-2026-XXXX for final bundling decisions before January 2027.

A group of House Republicans sent a letter to CMS Administrator Brooks-LaSure expressing significant concern over proposed Medicare payment cuts to 340B drugs in the 2027 Hospital Outpatient Prospective Payment System rule. The lawmakers argue the cuts would disproportionately harm safety-net hospitals and could reduce patient access. This political pressure increases uncertainty around whether the proposed cuts will be finalized as drafted. Hospitals and affiliated clinics participating in the 340B program should track the OPPS final rule closely, as the outcome will affect drug reimbursement for Medicare patients.

Illinois hospitals warn of a $2 billion financial loss due to changes in the Medicaid disproportionate share hospital (DSH) program. The federal funding shift, set to take effect next year, targets supplemental payments that many safety-net facilities rely on to offset uncompensated care. For independent practices that refer to or share patients with these hospitals, the cuts signal tighter referral networks and potential service reductions in obstetrics and emergency care. Monitor Illinois' 1115 waiver negotiations with CMS for possible mitigation; the state's ability to backfill the loss will determine local care access.

PhyxUp Health announced a new AI-powered billing platform built specifically for remote therapeutic monitoring and outpatient practices. The platform focuses on automating coding, claim submission, and denial management for high-volume, complex RTM billing, an area where CMS is proposing payment changes in the 2027 PFS. This launch reflects vendor recognition of growing administrative burden in chronic care management and signals a continued market shift toward specialty-specific RCM tools. No direct payer action is required, but practices evaluating RTM billing vendors should note the new entrant.

Arkansas insurance regulators approved an affiliation between Arkansas Blue Cross and Blue Shield and Cambia Health Solutions, parent of Regence BlueCross BlueShield. The deal creates a regional payer with deeper reserves but does not immediately change provider contracts or fee schedules. For practices in Arkansas and neighboring states, the consolidation reflects the ongoing trend of Blues plans seeking scale to manage medical costs and invest in technology. No credentialing or network changes are announced, but the combined entity may leverage its size in future rate negotiations. This is a market-structure shift to note, not an operational change today.