Month: October 2025

October 31, 2025

Bridget Early

Doctors who treat Medicare beneficiaries are getting a 2.5% raise next year under a regulation the Centers for Medicare and Medicaid Services issued Friday.

The 2026 Medicare Physician Fee Schedule final rule implements provisions from the tax law President Donald Trump enacted in July, which mandated a pay hike and reversed a multiyear trend of reimbursement cuts. CMS also spells out its plans for an “efficiency adjuster” that will reduce some payments, a lower back pain and heart failure payment model, and new flexibilities for telehealth coverage.

“The actions we are taking will improve seniors’ access to high-quality, preventive care that will help them to live longer, healthier lives,” CMS Administrator Dr. Mehmet Oz said in a news release.

October 24, 2025

Nona Tepper

Elevance Health has notified healthcare facilities they face penalties for assigning out-of-network clinicians to its members.

Starting Jan. 1, hospitals and other inpatient and outpatient facilities must ensure that all providers involved in care for members of Elevance Health’s Anthem Blue Cross Blue Shield commercial plans in 11 states are under contract with the insurer, Anthem said in a notice.

Facilities that don’t comply may be assessed administrative penalties equivalent to 10% of the allowed amounts payable under the claims in question, and may be terminated from Anthem networks. Facilities are not permitted to pass the cost of administrative penalties on to patients.

October 23, 2025

By Nona Tepper

Major health insurance companies are expanding where they sell exchange plans for 2026 despite uncertainty over rising costs and federal policy.

The biggest unknown is how Congress will deal with the enhanced exchange subsides that drove record enrollment in recent years but are scheduled to expire at the end of 2025. The issue is at the center of the showdown between the Republican congressional majority and the Democratic minority that led to the government shutdown that began Oct. 1.

Still, most exchange carriers are entering new states and counties for the 2026 plan year. The open enrollment period spans Nov. 1-Jan. 15 in most states.

October 15, 2025

Jeffrey Young

Medicare will hold claims for telehealth and hospital-at-home services while Congress is at an impasse over funding the government and renewing key healthcare programs, the agency said in a notice Wednesday.

The legal authorities for fee-for-service Medicare to cover telehealth and hospital-at-home care expired Oct. 1. CMS has instructed Medicare billing contractors to hold claims for services performed on or after that date, the agency said in the notice.

Congress failed to extend these programs amid the stalemate over fiscal 2026 government spending, which led to a shutdown that began Oct. 1.