Tuesday, September 15, 2026

Conifer Health Solutions, the revenue cycle management subsidiary of Tenet Healthcare, announced plans to eliminate over 1,000 positions. This follows Tenet's prior layoffs in its RCM unit earlier in September. The cuts signal continued pressure on traditional RCM margins, driven by payer consolidation, AI-driven automation, and a trend toward in-house billing operations among health systems. For independent practices, this underscores the instability of outsourcing to large-scale, hospital-owned RCM vendors and highlights the need to audit vendor contracts for termination or service-reduction clauses.

Provider and technology groups are warning that CMS's proposed 2027 Physician Fee Schedule could undercut remote patient monitoring programs. The proposal, detailed in the July 2026 rule, includes potential reductions to reimbursement for chronic care management and RPM services that many practices have built into their workflows. The American Hospital Association and other stakeholders have filed formal comments urging CMS to maintain payment levels to support patient access. The public comment period on the proposed rule closes September 30, 2026. Practices billing CPT codes 99453, 99454, and 99457 should monitor the final rule, expected in November, for changes to reimbursement and documentation requirements.

The American Hospital Association and the American Association of Orthopaedic Surgeons have submitted formal comment letters to CMS opposing the proposed 2.8% cut to the Medicare conversion factor for 2027. In its letter, the AHA argues the cut, combined with budget neutrality adjustments, would further strain hospitals and physician practices already facing inflationary pressures. The AAOS letter highlights concerns that reduced payments will exacerbate clinician shortages and limit patient access to surgical care. These industry comments are part of the final push before the September 30, 2026, deadline for feedback on the proposed rule. While the final rule is not binding, this coordinated opposition signals the operational impact of the cut if finalized.

Hospital executives are criticizing the Republican-backed $50 billion Rural Health Transformation Fund as insufficient to address the scale of rural hospital closures and service contractions. The program, launched in the 2025 fiscal year, is being deployed in states like Mississippi, which just awarded $104 million across 167 providers. Leaders argue the fund's complexity and scale fail to match the crisis, where closures limit maternity care and emergency services. This signals continued financial instability for rural providers dependent on Medicaid and Medicare, with no immediate legislative fix on the horizon.

A Florida couple reports that UnitedHealthcare denied inpatient stroke rehabilitation coverage twice, leaving them responsible for over $60,000 in out-of-pocket costs. The denials, which the payer upheld on appeal, highlight ongoing payer scrutiny of post-acute care setting appropriateness. For practices, this case underscores the increasing administrative burden and patient advocacy required when securing authorizations for intensive therapies. Monitor UHC's medical necessity criteria for rehab services; expect similar denials to prompt more patient complaints and potential media scrutiny.