News
- CMS Modernizes Nursing Home Oversight with New Risk-Based Survey Approach Designed to Highlight High Performance, Encourage Improvement
- Clinical Diagnostic Laboratories: Act Now Before Reporting Period Ends
- Medicare Providers: Join an Accountable Care Organization for Performance Year 2027
- Clinical Laboratories: Submit Your Comments on CLIA Regulations by September 14
- All Medicare Facility Types: Get Ready for the PEPPER Relaunch
- Medicare Beneficiary Date of Death: Manual Update
Compliance
Publications & Multimedia
News
CMS Modernizes Nursing Home Oversight with New Risk-Based Survey Approach Designed to Highlight High Performance, Encourage Improvement
CMS is introducing a more streamlined review process for higher-performing nursing homes, as well as an easier way for consumers to discover them when searching the CMS website. The Quality, Safety & Oversight Memo (PDF) outlines this risk-based survey process that strategically directs state agencies’ limited resources where they are needed most — by focusing fewer resources on the nation’s higher-performing nursing homes so states can address issues in nursing homes where residents’ health and safety are at greater risk. To identify these higher-performing facilities, CMS will place an icon on the Care Compare tool on Medicare.gov.
Read the full press release.
Clinical Diagnostic Laboratories: Act Now Before Reporting Period Ends
Are you an independent laboratory, physician office laboratory, or hospital outreach laboratory that meets the definition of an applicable laboratory under the Clinical Laboratory Fee Schedule (CLFS)? If so, you must report your data by July 31, 2026, or you may be subject to civil monetary penalties. Report data from January 1 – June 30, 2025, including:
- Applicable HCPCS codes
- Associated private payor rates
- Volume data
How do I report?
- Review CLFS Data Collection System resources:
- Identity Management Registration Guide (PDF)
- Submitter: User manual (PDF) and demo video
- Certifier: User manual (PDF) and demo video
- View the applicable HCPCS codes (ZIP)
- Use the Data Reporting Template (ZIP); see training video
CMS updated section 4 of the FAQs (PDF), including:
- Where can I find the laboratory tests subject to the data collection and data reporting requirements? — Revised
- Should we report each individual payor rate or the total amount of payment collected? — New
- Can I upload multiple files for my TIN? — New
More Information:
- CLFS & PAMA Reporting and Resources webpage
- CLFS: Reporting Private Payor Data (PDF) booklet
- Is My Lab an Applicable Lab? video
Medicare Providers: Join an Accountable Care Organization for Performance Year 2027
To participate in an Accountable Care Organization (ACO) for performance year 2027, work with an ACO to join their participant list. ACOs must submit their lists to CMS by August 5, 2026, by:
- Noon ET for the Medicare Shared Savings Program
- 11:59 pm ET for the Long-Term Enhanced ACO Design (LEAD) Model
Your taxpayer identification numbers can’t overlap multiple ACO participant lists. Resolve any overlaps by September 8, 2026.
More Information:
- Application Types & Timeline webpage
- Email questions to SharedSavingsProgram@cms.hhs.gov or LEAD@cms.hhs.gov
Clinical Laboratories: Submit Your Comments on CLIA Regulations by September 14
CMS is seeking public comments to help update the Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations. This request for information includes:
- Breath testing
- Laboratory processes and procedures
- Emergency preparedness, biosafety and biosecurity, and cybersecurity
- Specialty testing areas
Submit your comments by September 14, 2026.
All Medicare Facility Types: Get Ready for the PEPPER Relaunch
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is relaunching in the coming months for all Medicare facility types, including hospitals, post-acute care providers, and specialty facilities.
PEPPER is a free tool that helps you review your Medicare billing data so you can identify issues before problems arise and support accurate claims. Use it to:
- Spot billing patterns that may need review or improvement
- Identify areas that may need closer monitoring or internal audits
- Find services that may be under-coded or over-coded
- Track trends like longer patient stays
How to Get Your PEPPER
Authorized officials (AOs), access managers (AMs), and staff end users (SEUs) can download their organization’s report from the PEPPER Portal.
How to become an SEU:
- Sign in to the CMS Identity & Access (I&A) System using your existing NPPES or PECOS credentials.
- Request the PEPPER business function for your organization. The Comparative Billing Report business function is also available and can be requested at the same time.
- Your AO or AM must approve your request.
More Information:
- See the I&A Quick Reference Guide and FAQs: Step-by-step instructions for AOs and AMs
- Contact the External User Services Help Desk
Medicare Beneficiary Date of Death: Manual Update
CMS added section 210 to the Medicare Claims Processing Manual, Chapter 1 (PDF). Find out how to correct a date of death for Medicare records.
More Information:
- Fix Death Date Errors in Medicare Records (PDF) fact sheet
- Instruction to your Medicare Administrative Contractor (PDF)
Compliance
Enteral Nutrition: Prevent Claim Denials
In 2024, the improper payment rate for enteral nutrition was 23.8%, with a projected improper payment amount of $31.1M. Learn how to bill correctly for these services. Review the Enteral Nutrition provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Refill and documentation requirements
- Resources
Publications & Multimedia
DMEPOS Payments for Inpatient Stays
Learn how Medicare pays inpatient hospital facilities for DMEPOS items and services and get information on:
- DMEPOS inpatient payments
- What billers of DMEPOS items and services should know
- In-home DME coverage requirements
- DMEPOS deliveries before inpatient discharge
- Interruptions in period of continuous use of DME
- Interruptions in use of oxygen and oxygen equipment
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