Tag: Centers for Medicare & Medicaid Services (CMS)
In brief: Tightening enrollment, SOAR Act urgency, summer advocacy
July 2, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) on July 1 released a 2027 Home Health Prospective Payment System proposed rule that includes new provider enrollment provisions that would apply across Medicare provider and supplier types. Among them: The ability to claw-back payments retroactive to the date of noncompliance for all revocations.
Under current regulations, certain Medicare enrollment revocations become effective prospectively — specifically, 30 days after...
CMS, NPE contractors implement enrollment changes
June 23, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) recently implemented changes that it says will streamline the DMEPOS enrollment process, according to a bulletin from Novitas Solutions, the National Provider Enrollment (NPE) contractor for the East. For applications submitted on or after May 18, 2026, NPEAST will conduct a preliminary review within 10 calendar days of receipt. This review includes items such as exclusion checks, ownership review and accreditation verification...
In brief: AO oversight finalized, Medicaid oversight tightened, scam campaign launched
June 19, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid (CMS) has published a rule finalizing enhanced oversight of accrediting organizations (AOs).
The agency says the rule, “Strengthening Oversight of AO and Preventing AO Conflicts of Interest,” ensures that the organizations responsible for the oversight of more than 9,000 health care providers and suppliers use Medicare standards, and creates greater consistency between State Survey Agencies (SAs) and AOs in their survey processes.
“The...
CMS finalizes plans to increase oversight of AOs
June 18, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid (CMS) has published a rule finalizing enhanced oversight of accrediting organizations (AOs).
The agency says the rule, “Strengthening Oversight of AO and Preventing AO Conflicts of Interest,” ensures that the organizations responsible for the oversight of more than 9,000 health care providers and suppliers use Medicare standards, and creates greater consistency between State Survey Agencies (SAs) and AOs in their survey processes.
“The...
CMS finalizes changes to dispute resolution process
June 1, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has published a final rule that it says makes the Federal Independent Dispute Resolution (IDR) process more efficient and transparent, while saving money for millions of Americans. Since launching in April 2022, CMA says the Federal IDR process has received more than 5 million disputes – far exceeding expectations and creating delays and unnecessary costs. The agency says the rule addresses those bottlenecks by reducing ineligible...
CMS will not take action on Elevance Health at this time
June 1, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has notified Elevance Health that it will not impose intermediate sanctions on the insurer at this time. The agency says it is satisfied that Elevance has:
Completed the initial submission in its established electronic systems (Risk Adjustment Processing System, the Encounter Data Processing System and the Risk Adjustment Overpayment Reporting module); and
Remitted a wire transfer of the total overpayment amount based on...
CMS proposes changes to state-directed provider payment rates
May 21, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has published a proposed rule that would cap state-directed provider payment rates at 100% of Medicare payment rates for expansion states and 110% of Medicare payment rates for non-expansion states (or 100% of the Medicaid state plan rate if a comparable Medicare rate is not available).
The rule would also:
Apply similar limits to certain targeted Medicaid fee-for-service payments, and
Establish consistent national standards...
In brief: New moratorium, new Medtrade owner, new stay-of-enrollment scope
May 15, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) will implement a six-month, nationwide data-driven moratorium on new Medicare enrollment for hospices and home health agencies (HHAs).
CMS says the moratorium, which will temporarily halt the influx of new providers into these high-risk categories, continues the Trump Administration’s crackdown on fraud, waste and abuse in the Medicare program.
“We’ve seen systemic and deeply troubling fraud in the hospice...
CMS takes next step to improve prior authorizations
May 11, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services has added electronic prior authorization to its Health Tech Ecosystem. The agency says health systems, hospitals, physician practices, electronic health record (EHR) vendors and digital health developers are now joining payers as a unified coalition aligned around improving electronic prior authorization.
Working groups have been formed, vendors work to streamline process
Committed working groups across these stakeholders will...
In brief: ACU-Serve’s executive boost, CMS’s next prior auth move, McKesson’s & Medline’s results
May 11, 2026HME News Staff
AKRON, Ohio – ACU-Serve has appointed Natasha Baria Mehta as president, a strategic leadership addition that the company says reflects its continued investment in growth, operational excellence and innovation across the health care revenue cycle management (RCM) industry.
In this role, Mehta will oversee operational strategy, organizational performance and long-term growth initiatives across ACU-Serve’s HME, infusion and home health divisions. She will focus on strengthening operational...