Literature Review

Oct. 1 brings new codes, coding edits and Medicaid limits for practices Physicians Practice; by Keith A. Reynolds; 10/1/26 New ICD-10 codes, NCCI edits and Medicaid eligibility limits all took effect Oct. 1. Here's what practices should check this week. ...

How CMS’ proposed rule would build palliative care into the home health system Home Health Care News; by Morgan Gonzales; 9/30/26 The U.S. Centers for Medicare & Medicaid Services’ (CMS) proposal to add palliative care as a billable service under the Medicare Home Health Benefit could expand home health agencies to develop relationships with different types of providers. However, adding palliative care as a billable service could also make it difficult for home health providers to provide palliative services as robust as those delivered through the hospice benefit. Home health providers have celebrated the inclusion of palliative care in CMS’ proposed CY2027 home health payment rule. ... The rule will not change eligibility requirements for the home health care benefit. To qualify, a patient must: ...

Medicare fraud crackdown: what recent enforcement actions tell providers JD Supra; by Adam Appleberry; 9/28/26 ... Over the past several months, CMS and DOJ have announced a series of enforcement actions involving billions of dollars in suspected or allegedly improper Medicare claims. Although the cases involve different types of providers and different alleged conduct, several themes are beginning to emerge. ...

CMS cracks down on fraud, waste, and abuse in the Federal Health Insurance Marketplace® CMS Newsroom; Press Release; 9/22/26 As part of the ongoing efforts of the White House Task Force to Eliminate Fraud to crush fraud in the healthcare system and protect taxpayer dollars, the Centers for Medicare & Medicaid Services (CMS) is taking aggressive, sweeping actions within the Federal Marketplace — canceling approximately 315,000 unauthorized enrollments covering more than 760,000 individuals, which is expected to result in a return of roughly $2.2 billion in taxpayer-funded subsidies.  

The SSVI: connecting hospice relatedness, spending, and compliance risk | hospice relatedness, part 2 Community Health Accreditation Partner (CHAP); by Jennifer Kennedy, EdD, MA, BSN, RN, CHC; 9/18/26 ... Federal rules and CMS guidance make clear that, when a beneficiary elects hospice, the hospice assumes responsibility for related care. Services classified as unrelated should be exceptional and unusual; non-hospice spending should not be routine. (42 CFR §418.24; Medicare Benefit Policy Manual, Ch. 9). ...

National trends in types of hospice disenrollment among older adults with dementia, 2012–2019 Journal of the American Geriatrics Society; by Lauren J. Hunt, Siqi Gan, Krista L. Harrison, Melissa D. Aldridge, Claire Ankuda, W. John Boscardin, Alexandra K. Lee, and Alexander K. Smith; 9/15/26 Key Points

Update to 2026 hospice payment rate correctionFrom CMS; by Guest Editor Judi Lund Person; 9/9/26CMS has informed us on September 9, 2026 that there is a correction notice in clearance right now, which hopefully will be out soon. The change is minor and the wage index issue was across all payment systems, not just hospice. 

LeadingAge, coalition partners tell CMS: don’t punish good Medicare providers LeadingAge, Washington, DC; contact Colleen Knudsen; 8/31/26 In a joint sign-on letter led by LeadingAge, the association of nonprofit and mission-driven providers of aging services and submitted to the Centers for Medicare and Medicaid Services (CMS) today, a coalition of 19 partners representing hospitals, physician and clinician practices, post-acute and long-term care providers, home health and hospice agencies, suppliers, and the beneficiaries served by all, warn the agency that the proposed changes to Medicare provider enrollment provisions, included in the Calendar Year (CY) 2027 Home Health Prospective Payment System (PPS) Rule, risk penalizing legitimate providers and could result in limiting beneficiary access to care. The coalition fundamentally supports CMS’ responsibility to protect the Medicare Trust Fund and beneficiaries from fraud, waste, and abuse. However, ...

Mercy Hospice change in operator created conditions that posed ‘immediate jeopardy’ to patient well-being, state regulators say The Journal; by Jessie Bowman; 9/1/26 The ownership transition of Durango’s hospice program created serious problems in patient care and organizational oversight, according to state inspections that found multiple deficiencies and twice determined patients were at immediate risk of serious harm or death. In October 2025, the for-profit arm of the national CommonSpirit Health system – CommonSpirit Health at Home – took over ownership of the Mercy Hospice program. CommonSpirit assured the community the quality of care would not decline as a result of the transition. ... However, in May, the Colorado Department of Public Health and Environment conducted two concurrent relicensing inspections that found the ownership transition created system-wide deficiencies that led to clinical care practices and poor organizational oversight that put patient health and safety at serious risk. 

Alliance submits comments in response to CY 2027 Home Health Proposed Rule National Alliance for Care at Home, Alexandria, VA; Press Release; 9/1/26 The National Alliance for Care at Home (the Alliance) has submitted comments in response to the Centers for Medicare & Medicaid Services’ Calendar Year (CY) 2027 Home Health Prospective Payment System Rate and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program Updates proposed rule.  The letter notes that the Alliance appreciates that, for the first time since CY 2022, CMS proposes a full annual payment update, does not propose to apply a new permanent adjustment, [and ...] However, the comment also emphasizes that these decisions do not undo the harm already built into the payment rate, nor do they do enough to protect access to care across the country. 

AHA comments on CY 2027 Home Health proposed payment rule American Hospital Association; Press Release; 8/28/26 On behalf of our nearly 5,000 member hospitals, health systems and other healthcare organizations, including approximately 1,000 hospital-based home health (HH) agencies, our clinician partners — more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 healthcare leaders who belong to our professional membership groups, ... The AHA has two significant concerns. First, CMS’ proposed payment update of 2.4% is inadequate. ... Second, the proposed rule includes substantial changes to Medicare provider enrollment authorities that would apply not only to HH agencies but also to all providers and suppliers enrolled in Medicare. 

Week ahead in health care: MedPAC meeting with in-person audience Inside Health Policy; by Jessica Karins and Amy Lotven; 8/28/26 The Medicare Payment Advisory Commission (MedPAC) will meet Thursday (Sept. 3) and Friday (Sept. 4) virtually and, for the second time since the COVID-19 pandemic, with limited in-person public seating.

California and the federal government battle over hospice fraud, as victims lose coverage and care Regional Media News, Los Angeles, CA; by wrnnews.com; 8/26/26At 71 and a few years into retirement, Linda Henry felt like she was in good health, and only went to her doctor in Southern California for the occasional checkup. So it was a shock when she found out in 2024 that she had been enrolled in hospice, a specialized end-of-life care usually provided to people with six months or less to live. A Medicare worker told her the system said she had heart failure. Henry was a victim of rampant fraud in the hospice industry, a problem that’s been especially extreme in California, ... Henry believes her Medicare number was stolen after a healthcare payment portal that services insurances was hit by a cyberattack. She found out about her hospice enrollment in September 2024 after her doctor billed Medicare for an allergy test and was denied. Soon, other claims were being returned unpaid.