HHS has adopted the first HIPAA standards for electronic claims attachments and electronic signatures. This modernization replaces manual, paper‑based methods with standardized, secure electronic transactions, reducing administrative cost and improving claims turnaround.

CMS has released a revised Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, effective March 13, 2026. All providers who issue ABNs to Original Medicare beneficiaries must begin using the updated form by May 12, 2026.

A new federal law (H.R. 7148), signed on February 3, 2026, extends key Medicare telehealth policies that expanded access to virtual care during the pandemic. These flexibilities now remain in effect through December 31, 2027, providing much-needed stability for providers and patients alike.

United Healthcare is rolling out three significant policy updates in early 2026 that will impact claim processing and reimbursement. Here's what you need to know:

Congress has passed and the President has signed a Continuing Resolution (CR) to end the 43-day federal government shutdown and fund the government through January 30, 2026. As part of this package, Medicare telehealth flexibilities that expired on October 1 are now restored and extended through January 30, 2026. Additionally, telehealth services delivered during the shutdown will be covered retroactively.

CMS finalized the 2026 Medicare Physician Fee Schedule (PFS) rule on October 31, 2025. The rule updates payment policies, practice expense calculations, telehealth rules, and other Medicare Part B provisions.  This rule goes into effect January 1, 2026.

Telehealth is not gone, but the telehealth flexibilities introduced during the COVID-19 pandemic, which significantly expanded Telehealth, expired September 30, 2025. Several bills were introduced to extend Telehealth services but did not pass in Congress. This reverts Telehealth regulations for CMS (Centers for Medicare and Medicaid Services) to pre-pandemic rules.

Physician practices are experiencing a sharp increase in systematic downcoding by major commercial payors. This trend, driven largely by AI-powered algorithms, is resulting in significant revenue loss, higher administrative burden, and frustration for practices.

Cigna is significantly changing its commercial reimbursement policy for the Evaluation Management Service policy. This change goes into effect on October 1, 2025.

A $2.8 billion dollar class-action anti-trust settlement was reached between the plaintiffs (physicians, hospitals, large health systems, and provider organizations) and the Blue Cross and Blue Shield system (BCBS).