In recent weeks, the Centers for Medicare & Medicaid Services (CMS) has been incredibly active in releasing a slew of updates that aim to extend health coverage, improve maternal health, and combat fraudulent activities. Here’s a quick rundown of the most noteworthy updates and their broader implications.
On Aug. 11, CMS launched a call to action for all federal and state agencies working with children and families. The objective is to make sure that as many people as possible renew their Medicaid coverage. This all-hands-on-deck approach allows health plans, providers, and community organizations to utilize shared resources to keep children and families insured, especially as states return to standard Medicaid renewal procedures.
The same day, CMS approved Vermont’s extension of postpartum Medicaid coverage for up to a year. Made possible by the American Rescue Plan, this marks a significant milestone for maternal health. Now, 36 states, including the District of Columbia and the U.S. Virgin Islands, have expanded postpartum Medicaid coverage, aiming to combat the maternal health crisis in the U.S.
CMS’s Early 2023 Snapshot Report shows that 15.7 million people have effectuated their Affordable Care Act (ACA) Marketplace enrollments for February 2023, a 13-percent increase from the previous year. This surge is partly due to the American Rescue Plan (ARP) and the Inflation Reduction Act (IRA), which have made health insurance more affordable for millions.
Aug. 14 saw the release of the Request for Applications for the Making Care Primary (MCP) Model. Set to launch in July 2024, this voluntary primary care model will be tested in eight states and aims to improve care management, form partnerships with specialists, and address patients’ social needs like housing and nutrition.
CMS extended the mandatory spousal impoverishment provisions for home- and community-based services in Medicaid through September 2027. This policy protects a portion of a married couple’s resources, allowing married individuals to maintain their eligibility for necessary long-term care services.
New Jersey received an extension for its State Innovation waiver for an additional five years. Actuarial analysis predicts that this extension will result in premiums being 15.8 percent lower on average for individual health insurance coverage, starting from Plan Year 2024.
Lastly, CMS is stepping up its efforts to identify and weed out fraudulent hospice care providers. As of mid-August, unannounced site visits have been made to over 7,000 hospices to ensure compliance. Nearly 400 are under review for potential administrative action.
Through these various initiatives, CMS hopes to continue to make strides in ensuring that Americans have access to affordable, quality healthcare while keeping integrity and transparency at its core.
The first piece of news for today is that the Centers for Medicare & Medicaid Services (CMS) has finally released a new version of the
Federal officials announced this week that one of the nation’s largest health insurers has agreed to pay $117.7 million to resolve fraud allegations. The False
Please log in to your account to comment on this article.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s third quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s second quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
BLOOM INTO SAVINGS! Get 25% OFF during our spring sale through March 27. Use code SPRING26 at checkout to claim this offer.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
