Saturday, September 12, 2026

CMS is moving to reclassify algorithm-only laboratory-developed tests (LDTs) that do not require a physical sample as medical devices, potentially stripping them of traditional lab billing pathways. This change means tests that use existing patient data to generate a result would require a separate FDA pathway and could be excluded from standard Medicare Part B coverage. Labs offering predictive risk scores, some digital pathology tools, and AI-driven diagnostic software are directly impacted. Billing departments must identify any LDTs in their offering that fit this description and prepare for a potential coding and reimbursement shift when the rule finalizes. Review contracts and test menus now to assess exposure.

Tenet Healthcare's revenue cycle management business, Conifer Health Solutions, is cutting more than 1,000 positions. This significant downsizing coincides with the launch of Penguin AI's 'intelligent RCM' platform, which uses an AI workforce to target denial prevention. The dual signals point to accelerating consolidation and automation within the RCM sector, where legacy service models are under cost pressure. For independent practices, this means evaluating current RCM partners for stability and scrutinizing new AI-driven vendors for real operational proof, not just marketing claims. Monitor contract terms with large RCM providers for potential service disruptions or cost pass-throughs.

Oklahoma physicians are publicly stating that the proposed 2027 Medicare Physician Fee Schedule, which includes a 2.8% conversion factor cut and payment reductions for split or same-day visits, will destabilize practices and limit patient access. Their vocal opposition highlights the operational reality for specialties that rely on Medicare volume, particularly in rural and independent settings. The comment period for the proposed rule remains open. Practices should model the financial impact of the proposed cuts on their own service mix, especially for evaluation and management codes and any same-day therapy services. This local advocacy underscores the need to prepare internal budgets for a reduced Medicare fee schedule in 2027.

CMS restrictions on Medicare Advantage marketing lift October 1, triggering a six-week period when insurers can more aggressively advertise to beneficiaries. This annual window typically drives plan switching ahead of the Annual Election Period that starts October 15. Billing teams should prepare for patient questions about coverage changes and potential network disruptions as beneficiaries may shift plans based on new marketing materials. The eased rules apply to television, radio, and direct-mail advertising from October 1 through November 14. Monitor patient inquiries and verify insurance eligibility closely during this period, as mid-year plan changes can trigger claim denials and credentialing gaps.

The Texas Health and Human Services Commission is asking state lawmakers for additional funding to clear massive Medicaid and SNAP application backlogs. Delays in processing mean patients present with pending eligibility, forcing practices to choose between providing care without guaranteed payment or turning away Medicaid beneficiaries. The agency cites staffing shortages and outdated systems as primary causes. Texas practices should implement real-time eligibility checks for every Medicaid patient at point of service and consider requiring patients to bring proof of active coverage before scheduling non-emergent visits. Document all attempts to verify eligibility, as retroactive approvals may hinge on demonstrating due diligence.