Wednesday, September 9, 2026

CMS identified an error in its calculation of 2027 hospice payment rates and is now recalculating them. The agency will issue revised rates, which will impact Medicare reimbursement for hospice services starting October 1, 2026. Hospices must wait for the corrected payment update before finalizing their 2027 operational budgets and billing system configurations. The recalculated rates will be published in a forthcoming CMS transmittal. Hospice finance teams should hold their 2027 rate implementation plans and watch for the official correction from CMS to avoid billing under outdated, incorrect rates.

Anthem reversed a prior denial and will now cover breast reconstruction mesh for a Florida patient. This shift follows public reporting of the case where the payer initially cited the procedure as cosmetic. The reversal signals potential internal policy review at Anthem regarding post-mastectomy reconstruction. For oncology and plastic surgery practices, this case underscores the importance of robust medical necessity documentation, particularly for procedures payers may initially classify as cosmetic. Monitor Anthem's provider communications for any formal policy updates related to CPT codes 19357 or 19367.

A new analysis from the Georgetown University Center for Children and Families concludes planned federal Medicaid cuts will reduce access to hospital obstetric services in rural communities. The report links funding reductions to hospital closures, which directly limits where pregnant patients can deliver. This follows a recent American Hospital Association report tracking a decline in obstetric service availability nationwide. For practices with obstetric lines, this shift means more patients may travel farther for deliveries, complicating post-partum follow-up and continuity of care. Monitor Medicaid reimbursement proposals in your state; rural clinics may see increased pressure to fill gaps in prenatal and post-partum care as hospital options shrink.

The Departments of Health and Human Services and Justice have opened investigations into more than 250 health care entities regarding gender-affirming care provided to minors. This coordinated federal enforcement action signals heightened scrutiny on billing and medical necessity documentation for these services. The probe likely focuses on alleged violations of federal statutes, including potential False Claims Act implications. For practices offering pediatric gender-affirming care, this action underscores the critical need for rigorous documentation, clear medical necessity justifications in the medical record, and strict adherence to clinical guidelines. Review internal compliance protocols for these services, ensuring your documentation can withstand audit.

Cambia Health Solutions and Arkansas Blue Cross Blue Shield have finalized their affiliation. The deal combines Cambia's operations across several western states with Arkansas Blue Cross's local market. For providers in Arkansas and surrounding regions, this consolidation may lead to changes in contracting, network policies, and claims processing systems over the next 12-18 months. While immediate workflows are unchanged, credentialing and provider relations teams should note the combined entity for future contract negotiations. The affiliation reflects ongoing payer consolidation, which typically centralizes administrative functions like prior auth and appeals.