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All posts tagged with “Regulatory News | Medicare.”
When the enrollment freeze ends, claim review takes over — small providers need clear rules
11/13/26 at 03:00 AMWhen the enrollment freeze ends, claim review takes over — small providers need clear rules MedCity News; by Jamie Davis; 11/12/26 For six months, Medicare’s main answer to home health and hospice fraud has been a closed door. On May 13, CMS stopped enrolling new hospices and home health agencies nationwide, along with new branch locations and certain ownership changes. A moratorium lasts six months unless CMS extends it, so the scheduled end is November 13. CMS says the freeze is working. A senior official said this fall that about 250 home health agencies and 50 hospices were denied enrollment in the first five months. I believe it. But a closed door is a blunt tool, and it was never built to stay shut. What replaces it? Everything I’m seeing points to more claim review for the agencies already inside.
BREAKING NEWS: Nationwide temporary moratorium on enrollment of hospices extended and modified
11/13/26 at 01:00 AMCMS Hospice Moratorium
New CMS rule ties Medicare billing privileges to owners’ misconduct
11/09/26 at 03:00 AMNew CMS rule ties Medicare billing privileges to owners’ misconduct Rev Cycle Managment | TechTarget; by Jacqueline LaPointe; 11/6/26 Dive Brief:
Medicare can recover payments back to the day noncompliance began under Final CMS Home Health Rule
11/09/26 at 03:00 AMMedicare can recover payments back to the day noncompliance began under Final CMS Home Health Rule Medical Daily; by Joseph James; 11/6/26Medicare enrollment revocation retroactive to the date a provider's noncompliance began, giving the agency a way to recover payments made before a revocation notice ever went out. The changes sit inside the calendar year 2027 home health final rule issued Nov. 4, but most of them reach far beyond home health and apply to Medicare providers and suppliers of every type. CMS estimates the enrollment changes will save taxpayers about $82 million a year, according to its MLN Connects provider newsletter. Under the old rules, only some revocation grounds were retroactive. Most revocations took effect 30 days after a notice was mailed, leaving a window in which a noncompliant provider could keep billing.
Hospice SSVI explained: what your score isn’t telling you | part two
11/09/26 at 02:00 AMHospice SSVI explained: what your score isn’t telling you | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Lindsay Doak; 11/4/26 Your hospice’s SSVI score tells a story—but it may leave out the context that matters most. ...Five key takeaways:
CMS finalizes 2027 Home Health Rule with sweeping regulatory changes
11/06/26 at 03:00 AMCMS finalizes 2027 Home Health Rule with sweeping regulatory changes Hospice News; by Jim Parker; 11/4/26 The U.S. Centers for Medicare & Medicaid Services (CMS) has finalized its 2027 home health rule, which contains significant regulatory updates that affect all healthcare providers. In addition to those provisions, the agency implemented an aggregate payment increase of 2.4%, or approximately $420 million, a departure from recent years in which home health providers have faced reimbursement reductions. CMS is adopting new measures to strengthen oversight of Medicare providers and combat fraud, waste and abuse under its calendar year 2027 home health payment rule.
National Alliance for Care at Home responds to CY 2027 Medicare Home Health Final Rule, citing continued need for reimbursement stability and targeted oversight
11/06/26 at 03:00 AMNational Alliance for Care at Home responds to CY 2027 Medicare Home Health Final Rule, citing continued need for reimbursement stability and targeted oversight National Alliance for Care at Home, Alexandria, VA; Press Release; 11/4/26 The National Alliance for Care at Home (the Alliance) today responded to the Centers for Medicare & Medicaid Services (CMS) calendar year (CY) 2027 Home Health Prospective Payment System final rule. The payment update finalized by CMS offers greater stability amid a challenging operating environment, yet the Alliance remains concerned that the finalized 3% temporary payment adjustment may undermine providers’ ability to deliver care in the home. The Alliance is also alarmed that broad provider enrollment provisions may have unintentional consequences for legitimate providers.
Behind the scenes: how CMS combats hospice fraud
11/05/26 at 03:00 AMBehind the scenes: how CMS combats hospice fraud Hospice News; by Jim Parker; 11/4/26 The U.S. Centers for Medicare & Medicaid Service (CMS) is locking horns with scammers, and hospices need a transparent view into the agency’s methods. CMS routinely monitors billing activity, beneficiary complaints and other indicators that may signal potential fraud, an agency spokesperson told Hospice News. When suspicious activity is identified, the agency can take several actions, including suspending payments, revoking Medicare billing privileges and referring cases to law enforcement.
Amid fraud crackdown, home-based care operators look to differentiate
11/05/26 at 03:00 AMAmid fraud crackdown, home-based care operators look to differentiate Home Health Care News; by MK Manoylov; 11/2/26 Home-based care providers are facing a significant surge in fraud enforcement, but the heightened scrutiny may also provide compliant operators an unexpected way to stand out. To differentiate themselves from fraudulent operators, home-based care providers are placing greater emphasis on documentation, audit readiness, accurate enrollment records and policy reviews to highlight their regulatory compliance, industry leaders said during a FUTURE panel in August.
Hospice SSVI explained: what your score isn’t telling you | part one
11/05/26 at 03:00 AMHospice SSVI explained: what your score isn’t telling you | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Lindsay Doak; 11/4/26 Your hospice’s SSVI score tells a story—but it may leave out the context that matters most. ...Five key takeaways:
Ills of Medicare Advantage plans are becoming clearer and clearer
11/04/26 at 03:00 AMIlls of Medicare Advantage plans are becoming clearer and clearer PressReader | The Boston Globe; by Renee McInnes; 11/3/26 As a provider of home care and hospice care, we identify with the struggles of Sarah Iselin, chief executive of Blue Cross Blue Shield of Massachusetts (“Blue Cross eliminates several Medicare Advantage plans, affecting 20,000 seniors”). Health care leaders in every sector are coping with the challenges of our failed system. But it must be made explicit that Medicare Advantage is a terrible product for patients — as it is now, apparently, for the bottom line of the state’s largest insurer. A total of $275 million in losses with these plans in 2024 and 2025 is a remarkable number for Blue Cross to report. However, I would remind the health care community that the home care and hospice space is being gutted, and the ultimate loser in this equation is our patients.
Medicare Program; CY 2027 changes to the End-Stage Renal Disease (ESRD) Prospective Payment System, Acute Kidney Injury (AKI) Dialysis Payment, and ESRD Quality Incentive Program
11/04/26 at 02:00 AMMedicare Program; CY 2027 changes to the End-Stage Renal Disease (ESRD) Prospective Payment System, Acute Kidney Injury (AKI) Dialysis Payment, and ESRD Quality Incentive Program Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS)Federal Register | Medicare Program; 10/30/26 Summary: This final rule updates and revises the End-Stage Renal Disease (ESRD) Prospective Payment System for calendar year 2027. This rule also includes updates to the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury. In addition, this rule updates the requirements for the ESRD Quality Incentive Program. Dates: These regulations are effective on January 1, 2027.
How Medicare Advantage and traditional Medicare influence palliative and hospice care implementation: a conversation with Xin Hu, PhD
11/02/26 at 03:00 AMHow Medicare Advantage and traditional Medicare influence palliative and hospice care implementation: a conversation with Xin Hu, PhD The ASCO Post; by Jo Cavallo; 10/29/26 In 2024, ASCO updated its guideline for the integration of palliative care in oncology, ... However, despite ASCO’s recommendations, utilization of palliative care in the oncology setting remains low, with about one-third of patients globally receiving this service, with the highest utilization rate of nearly 56% in Africa and the lowest, 30%, in the United States. The results from two studies by Xin Hu, PhD, MSPH, and her colleagues evaluating the use of early palliative care among traditional Medicare and Medicare Advantage beneficiaries with advanced cancers find that systemic and structural barriers in the health-care system are contributing to the underuse of palliative care among these patients.
How the government is thinking about hospice payment reform
11/02/26 at 02:45 AMHow the government is thinking about hospice payment reform Hospice News; by Jim Parker; 10/30/26 Congress and federal agencies have been examining the prospect of adjusting – or overhauling – hospice reimbursement systems. This is based on introduced pieces of legislation and a series of government reports from agencies like the Government Accountability Office (GAO), the U.S. Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services Office of the Inspector General (OIG). The Medicare Payment Advisory Commission (MedPAC) has also chimed in. This represents a larger trend in the federal government, Katie Wehri, vice president of policy, quality and compliance for the National Alliance for Care at Home said. Wehri made these remarks during a session at the Alliance’s Annual Conference.
Medicare freeze on new hospice and home health agencies expires November 13 as CMS stays silent
11/02/26 at 01:00 AMMedicare freeze on new hospice and home health agencies expires November 13 as CMS stays silent Medical Daily; by Joseph James; 10/29/26 A Deadline Two Weeks Away and No Word From CMS: A nationwide freeze that has blocked new hospices and home health agencies from enrolling in Medicare since May is set to expire on Nov. 13, and the federal government has not said whether it will keep the freeze in place. The Centers for Medicare & Medicaid Services told providers it would give at least 60 days' notice before the moratoria expire, according to Home Health Care News. As of Oct. 30, no extension notice had been published, leaving hospitals, discharge planners, and families without a clear picture of what the end-of-life and in-home care market will look like in two weeks.
Palliative care for advanced cancer in Medicare Advantage and physician networks
10/31/26 at 03:15 AMCMS COO: Moratorium has blocked 250 home health agencies from Medicare enrollment
10/30/26 at 03:00 AMCMS COO: Moratorium has blocked 250 home health agencies from Medicare enrollment Home Health Care News; by Morgan Gonzales; 10/29/26The moratorium on Medicare home health enrollment has blocked 250 agencies that applied from gaining approval, according to Kim Brandt, the deputy administrator and chief operating officer of the Centers for Medicare & Medicaid Services (CMS). The moratorium on hospice enrollment, meanwhile, has blocked 50 hospices from enrolling, she added, saying that she was surprised at the proportion of home health versus hospice enrollment attempts.
[Australia] Home care fraud, waste and abuse: Australia’s lessons for the U.S.
10/30/26 at 03:00 AM[Australia] Home care fraud, waste and abuse: Australia’s lessons for the U.S. FTI Consulting; 10/27/26 Key Takeaway: Australia’s home care model offers U.S. providers and policymakers a practical lesson: Strengthen payment integrity through accountable providers, coordinated care and transparent billing that helps consumers flag irregularities, while preserving access to essential services. ...
Patients with suboptimal discharges – a follow-up (and rescinding hospice billing)
10/30/26 at 03:00 AMPatients with suboptimal discharges – a follow-up (and rescinding hospice billing)RACmonitor; by Ronald Hirsch, MD, FACP, ACPA-C, CHCQM, CHRI; 10//28/26 Let me start with an update on my project to get a way to indicate on a hospital claim that a patient has discharged to a less-than-optimal location. ... [That began] with a push to use the “against medical advice” designation for such patients. But the stigma behind that term led me to adopt the suggestion of Valerie Rinkle, a nationally known revenue integrity expert, who proposed adoption of a condition code instead of using a discharge status code. Last week I once again presented to the National Uniform Billing Committee (NUBC), asking for such a code to be established. During that meeting, one of the members came up with an even better idea: establishing two condition codes, one for when the patient chooses a less-than-optimal location, and a different condition code for when the payer refuses to approve the suggested post-acute care.
Key takeaways from the Fiscal Year 2027 Hospice Final Rule
10/30/26 at 02:00 AMKey takeaways from the Fiscal Year 2027 Hospice Final Rule Husch Blackwell; podcast and transcript by Bryan K. Nowicki, Andrew Brenton, and Brooke Griffin; 10/27/26 CMS’s Fiscal Year 2027 final rule includes the introduction of the Service and Spending Variation Index, significant changes to the hospice election statement addendum, and requests for information on community palliative care and medical aid in dying that reveal CMS’s future priorities. In this episode, Bryan Nowicki, Andrew Brenton, and Brooke Griffin walk through what hospices need to know about the final rule.
CMS COO: hospice, home health moratoria a successful approach
10/30/26 at 02:00 AMCMS COO: hospice, home health moratoria a successful approach Hospice News; by Jim Parker; 10/29/26 The U.S. Centers for Medicare & Medicaid Services’ (CMS) temporary moratoria on hospice and home health provider enrollment in Medicare has been working, according to Kimberly Brandt, the agency’s deputy administrator and COO. To date, during the six-month enrollment freeze, CMS has denied 50 hospice and 250 home health applications. Also, CMS has seen “huge drops” in billing, particularly in geographic areas known to be rife with fraud. This includes states like California, Texas, Nevada, Ohio, Georgia and Arizona.
Inside the evolving SNF-hospice relationship as OIG aims to get hospice numbers under control
10/29/26 at 02:00 AMInside the evolving SNF-hospice relationship as OIG aims to get hospice numbers under control Skilled Nursing News; by Amy Stulick; 10/27/26 Federal officials are homing in on the financial relationship between nursing homes and hospice providers, notably when that relationship affects potential Medicare savings and payment inefficiencies for hospice care in such settings. An Office of the Inspector General (OIG) work plan, announced in July, aims to determine Medicare payments for hospice care provided in a nursing home, and estimate cost savings from reducing the payment to address inefficiencies in payment structure. OIG also seeks to examine the practices of hospice providers with a high percentage of beneficiaries living in nursing homes.
HHS drops expired 2025 Alzheimer's treatment goal in new dementia plan focused on prevention and early detection
10/28/26 at 03:00 AMHHS drops expired 2025 Alzheimer's treatment goal in new dementia plan focused on prevention and early detection Medical Daily; by Cole Mercer; 10/27/26 The federal government has rewritten its national dementia strategy, shifting the focus toward prevention and earlier detection. HHS Secretary Robert F. Kennedy Jr. announced the updated national plan on Alzheimer's and related dementias on Oct. 22 at Broward Health Medical Center in Fort Lauderdale, Florida. The new plan replaces six long-standing goals with four. ...
Physician organizations back new challenge to Medicaid work rule
10/28/26 at 03:00 AMPhysician organizations back new challenge to Medicaid work rule American Medical Association (AMA), Chicago, IL; Press Release; 10/27/26 The American Medical Association (AMA) and the Maryland State Medical Society (MedChi), joined by several national physician organizations, filed an amicus brief in Taylor v. Kennedy, a new lawsuit challenging federal regulations that make it harder for people with serious or complex medical conditions to qualify for an exemption from Medicaid work requirements. The brief, filed in the U.S. District Court for the District of Maryland, supports the plaintiffs’ motion for summary judgment and argues that the Centers for Medicare & Medicaid Services (CMS) exceeded its statutory authority by imposing narrow restrictions on the medical frailty exemption established by Congress under H.R. 1, the One Big Beautiful Bill Act.
Free webinar for physicians and healthcare professionals: Veterans nearing the end of life - distinct needs, specialized care
10/28/26 at 12:00 AMFree webinar for physicians and healthcare professionals: Reducing hospital readmissions and reducing Hospital Readmissions and Length of stay in advanced illness patients VITAS Healthcare; Press Release; 9/14/26