Category: News

August 27, 2026

Noah Tong

Insurers have a new headache to relieve when it comes to the No Surprises Act.

A federal appeals court this month affirmed a ruling requiring the government to scrap how it calculates a key metric that determines reimbursements for out-of-network claims through the Independent Dispute Resolution process. The decision will force federal agencies to issue new guidance, according to the Centers for Medicare and Medicaid Services. The new policy parameters will require insurers to change how they work out the qualifying payment amount, which is the inflation-adjusted median in-network rate for a service under the No Surprises Act.

August 26, 2026

Alex Kacik

Private equity-backed healthcare transactions have slowed as states increase merger and acquisition oversight.

Dealmaking in physician practice management, the healthcare sector that typically attracts the most private equity investment, is on pace to decrease 46% this year compared with 2025, according to a recent report from financial data and research company Pitchbook. The slowdown is in part linked to states that have passed laws requiring private equity firms to notify regulators of their proposed transactions or have banned certain types of deals commonly used by corporate investors.

July 31, 2026

Bridget Early

Medicare pay for specialist physicians would undergo steep cuts while primary care reimbursement would rise under a plan the Centers for Medicare and Medicaid Services unveiled this month.

The agency proposed a slate of policies this month that would effectively reduce reimbursement for some specialty services and boost pay for certain routine primary care visits. CMS can only accomplish the latter goal by cutting expenditures in other areas under a legal standard known as “budget neutrality” that doesn’t allow the agency to add more than $20 million a year in new spending.

July 14, 2026 

Jeffrey Young
Physicians would see a small Medicare pay cut next year under a proposed rule the Centers for Medicare and Medicaid Services issued Tuesday.

The conversion factor of the Physician Fee Schedule — the key multiplier that determines payment amounts for specific services — would decline 1.7% to $32.84 for most doctors and 1.2% to $33.17 for physicians participating in Medicare’s advanced alternative payment models. This partly reflects the expiration of a one-year reimbursement bump enacted in President Donald Trump’s tax law.

June 23, 2026

Michael McAuliff

States are charting the future of artificial intelligence in healthcare as Congress idles and President Donald Trump shows reluctance to interfere with a burgeoning industry.

Federal lawmakers have talked a lot about AI and sometimes threatened to usurp state powers to regulate the technology. But Congress has not acted in a meaningful way and national regulators are busier using AI than defining or limiting how others use it.

June 16, 2026

Bridget Early

The race is on for states to iron out their Medicaid work requirement plans and tie up loose ends for providers, insurers and beneficiaries.

The Centers for Medicare and Medicaid Services issued a long-awaited regulation this month laying out federal standards for work requirements. But states facing down a Jan. 1, 2027, deadline to have the system running will have to quickly rethink their strategies because CMS caught them by surprise on key issues.

May 13, 2026

Bridget Early

The Centers for Medicare and Medicaid Services on Wednesday temporarily paused new home health and hospice enrollment into Medicare.

The agency issued a six-month freeze on new provider enrollments as part of its latest effort to crack down on fraud in the healthcare system. CMS will increase investigations and accelerate the removal of hospice and home health providers suspected of fraudulent activity while the moratoria are ongoing, along with employing new data analytics to scrutinize the sector, CMS said in a news release.

May 06, 2026

Tim Broderick
Kevin Davis

Demand is rising for nurse practitioners and physician assistants, leading to greater incentives and more complex recruitment tactics from employers.

But not all specialties are compensated equally, according to respondents to Modern Healthcare’s first Advanced Practice Provider Compensation Survey.