2026 is shaping up to be a pivotal year for health care reimbursement.
From major CMS payment rules to evolving disclosure requirements, AI scrutiny, and mounting pressure on providers across the care continuum, the 2026...more
1/22/2026
/ Centers for Medicare & Medicaid Services (CMS) ,
Disclosure Requirements ,
Enforcement Actions ,
Enrollment ,
Guidance Update ,
Health Care Providers ,
Health Insurance ,
Healthcare Facilities ,
Home Health Care ,
Hospice ,
Hospitals ,
Medical Devices ,
Medical Equipment ,
Medical Reimbursement ,
Medicare ,
PECOS ,
Physician Fee Schedule ,
Physicians ,
Price Transparency ,
Regulatory Oversight ,
Regulatory Requirements ,
Reimbursements ,
Revocation ,
Rural Health Care Providers
Key Takeaways -
CMS maintains its authority to impose Medicare reenrollment bars: CMS emphasizes its ability to apply reenrollment bars when a provider’s Medicare billing privileges are revoked, affecting all enrollments...more
Key Takeaways -
CMS has paused most certification and survey activities during the government shutdown....more
Key Takeaways -
House Bill 3749, also known as Jenifer’s Law, goes into effect on September 1, 2025, and applies only to elective IV therapy provided outside physician offices or licensed health facilities....more
Key Takeaways -
1. Centers for Medicare & Medicaid Services (CMS) Aims to Strengthen Enforcement -
The agency is evaluating how to better enforce hospital price transparency rules under the Executive Order....more
Centers for Medicare & Medicaid Services (CMS) released several pieces of Medicare provider enrollment guidance this spring, both emphasizing current policy and requirements as well as providing guidance and clarification...more
The Centers for Medicare & Medicaid Services (“CMS”) published proposed changes to the Medicare Provider Enrollment requirements in the 2024 Medicare Physician Fee Schedule Proposed Rule (the “Proposed Rule”). If finalized,...more
On July 1, 2021, the Departments of Health and Human Services (“HHS”), Treasury, and Labor, along with the Office of Personnel Management (collectively the “Departments”), issued the first tranche of regulations implementing...more
9/30/2021
/ Biden Administration ,
Drug Pricing ,
Health Care Providers ,
Health Insurance ,
Healthcare Reform ,
Interim Final Rules (IFR) ,
Legislative Agendas ,
Medical Reimbursement ,
Out of Network Provider ,
Price Transparency ,
Provider Relief Fund ,
Regulatory Agenda ,
Surprise Medical Bills ,
Value-Based Care
On November 15, CMS issued the Price Transparency Requirements for Hospitals to Make Standards Charges Public Final Rule (“Final Rule”), as directed by President Donald Trump’s Executive Order on Improving Price and Quality...more
11/26/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Executive Orders ,
Final Rules ,
Health Care Providers ,
Healthcare Reform ,
Hospitals ,
Medical Examinations ,
Medical Expenses ,
Pharmaceutical Industry ,
Pricing Requirements ,
Regulatory Requirements ,
Rulemaking Process ,
Service Charges ,
Surprise Medical Bills ,
Transparency ,
Trump Administration
Polsinelli is pleased to share the Health Care Reimbursement and Payor Dispute Update. This newsletter is a designated source of news, information and guidance on the constantly evolving reimbursement industry.
...more
11/1/2019
/ Administrative Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Contract Disputes ,
Enrollment ,
Health Care Providers ,
Injunctive Relief ,
Managed Care Contracts ,
Medical Reimbursement ,
Medicare ,
Payor Contracts ,
Revocation ,
Site-Neutral Exception ,
Universal Health Services Inc v United States ex rel Escobar
On November 1, 2018, the Centers for Medicare & Medicaid Services (“CMS”) released an advanced copy of the final rule announcing policies and payment levels for the Medicare Physician Fee Schedule for 2019, implementing...more
The Center for Medicare & Medicaid Innovation (CMMI) is seeking ideas on how to better drive change and reduce regulatory burden. CMMI solicited ideas to shape the agency’s future activities through a September 2017 “request...more
The Centers for Medicare & Medicaid Services (CMS) published a proposed rule on the Medicare Quality Payment Program (QPP) in the Federal Register1 on June 30, 2017. This rule proposes the QPP program requirements for...more
The recent federal grand jury indictment of 21 health care executives, investors, and physicians in connection with the now defunct Dallas-based Forest Park Medical Center effectively turned the Texas health care compliance...more
2/2/2017
/ Bribery ,
Department of Justice (DOJ) ,
Federal Health Care Programs (FHCP) ,
Health Care Providers ,
Healthcare ,
Indictments ,
Investors ,
Kickbacks ,
Out of Network Provider ,
Patient Referrals ,
Physicians ,
Travel Act
The Centers for Medicare & Medicaid Services (CMS) recently released its final rule with comment period implementing the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Among its numerous changes,...more
11/9/2016
/ Alternative Payment Models (APM) ,
CEHRT ,
Centers for Medicare & Medicaid Services (CMS) ,
Health Care Providers ,
Healthcare ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
MIPS ,
Physician Medicare Reimbursements ,
Physicians ,
PQRS ,
Quality Payment Program (QPP) ,
Sustainable Growth Rate (SGR)
Olympus Corporation of the Americas, the United States’ largest distributor of endoscopes and related medical equipment, recently agreed to pay $623.2 million to resolve criminal charges and civil claims, according to a...more