Reimbursement pains

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.

Hold times, delayed approvals and denials on authorized care dominated member feedback to MGMA's government affairs team.

MGMA is pushing back on any delay as insurers describe a three-step build.

Three big payers are moving to shared credentialing through CertifyOS. What it could fix for practices and what it leaves on your desk.

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.

A delay would leave practices without the information they need to train staff and test workflows before the deadline, the AMA told CMS.

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.