Reimbursement

Medicaid work requirements, new remote monitoring rules and an electronic prior authorization deadline all land Jan. 1, and that's only part of what MGMA told practice leaders to watch.

MGMA's Anders Gilberg says few practices have heard from EHR vendors about the Jan. 1 prior authorization API deadline.

Traditional MIPS would end after 2028 under a CMS proposal. Practices that want an MVP for 2026 must register by Nov. 30 at 8 p.m. EST.

Heel pain gets laterality, BRCA gets its own code and liver fibrosis gets a middle stage. These are the FY 2027 additions your physicians will reach for.

A House hearing put the Patients First Act and four related bills in play. Here is how each would change Medicare pay and practice rules.

MGMA is fighting a 2027 Medicare proposal that would halve payment when an office visit and a procedure land on the same day.

The FY 2027 code set lands Oct. 1 with no grace period. Deleted codes, quiet demotions and new laterality rules start denials on Day 1.

Payers must turn on four prior authorization APIs by Jan. 1. Practices have no deadline, which is why most will get nothing from it.

Medicare's comment window on the 2027 fee schedule closes Sept. 14. Here is how to file one that CMS will actually read.

Nearly 150 medical groups want CMS to fix same-day E/M overlap code by code instead of cutting payment 50 percent.

One line in a payer contract just cut 40% of a Hawaii clinic's panel.

Comments on Medicare's CY 2027 pay rule close Sept. 14. These 10 proposals will cost practices the most if they are finalized as written.

The comment window closes Sept. 14, and the same rule already previews what a coding transition looks like operationally.

CMS blocked $1.6 billion in suspect lab payments, and new rates land Jan. 1. Ten checks to run on your in-office lab first.

The AMA is pressing CMS to withdraw a proposed 50 percent cut for office visits billed the same day as a procedure.

Medicare wants to pay half for the lesser service on same-day claims. Our new handbook works out what modifier 25 encounters stand to lose.

Shawntea Gordon of Atlas & Perpetua Healthcare Consulting says a cost cut made without benchmarking data is a guess, and the wrong guess costs more than it saves.

Joanne Frederick of Government Market Strategies argues the fix for runaway health care costs turned out worse than the problem it solved.

Medicare would pay for RPM and RTM only when practice-employed clinical staff do the work under the CY 2027 fee schedule proposal.

Staffing shortages, training gaps and insurance verification delays are the front-end problems dragging on patient access, and nearly all of them land on the administrator's desk. Experian Health's chief operating officer breaks down which ones automation can absorb now and which ones still need payer or policy reform.

The proposed 2027 Medicare fee schedule shifts payment between specialties and changes same-day billing as MIPS winds down, and MGMA's Anders Gilberg explains what practice leaders should watch before comments close Sept. 14.

A new Physicians Practice handbook breaks down the 2027 Medicare fee schedule proposal, with worked math on what practices stand to lose.

MGMA's Anders Gilberg says the cuts land hardest on independent groups, calls MVPs 'MIPS on steroids' and expects any fix to wait for a lame duck Congress.

Most physicians know the direct primary care pitch; whether the economics hold up once you're in it is the harder question.

Physician pay rose in 2025 even as productivity fell, MGMA data shows. MGMA's Andy Swanson on what the split means for practices.