MLN Connects Newsletter for March 26, 2026

CMS is slashing wasteful spending and antiquated paperwork by swapping out faxing and mailing for streamlined electronic transactions. This action lets providers spend less time on administrative hassle and more time caring for patients.

The Administrative Simplification; Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures final rule is projected to save the health care industry roughly $781M annually by establishing national standards for the electronic exchange of clinical documentation used to support health care claims. The rule also adopts standards for electronic signatures to ensure secure, authenticated transmission of this information.

The rule is effective on May 26, 2026. Covered entities must comply by May 26, 2028.

More Information:

Hospitals: OPPS Drug Acquisition Cost Survey Deadline Extended to April 7

The deadline for the Outpatient Prospective Payment System (OPPS) Drug Acquisition Cost Survey (ODACS) is extended to April 7, 2026. Hospitals paid under OPPS and listed on this ODACS provider table (PDF) must submit their drug acquisition cost data to CMS by the new deadline.

To complete the survey, you must:

Follow the steps in the Registration User Guide (PDF) to register for the online system
Upload your drug acquisition cost data using this template (ZIP)
Follow the steps in the Submitter User Guide (PDF) to complete the online attestation form
Submit your data by April 7

More Information:

Visit the ODACS webpage for official guidance on the survey
Read FAQs (PDF)
Contact OPPSDrugSurvey@cms.hhs.gov with questions

Clinical Diagnostic Laboratories: Get Ready to Report Starting May 1

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 data from May 1 – July 31, 2026, based on an updated data collection period of 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:
View the applicable HCPCS codes (ZIP)
Use the Data Reporting Template (ZIP)

More Information:

CLFS & PAMA Reporting and Resources webpage
FAQs

Nutrition-Related Health Conditions: Recommend Medicare Preventive Services

During National Nutrition Month®, encourage your patients to develop healthy eating and physical activity habits. Medicare covers 8 preventive services for nutrition-related health conditions like diabetes, chronic kidney disease, cardiovascular disease, and obesity:

Find out when your patient is eligible for these services (PDF). If you need help, contact your eligibility service provider.

Information for Your Patients:

Compliance

Acute Care Hospital Outpatient Services for Hospice Enrollees: Reduce Improper Payments

In a report, the Office of Inspector General found that Medicare improperly paid acute-care hospitals for outpatient services provided to hospice enrollees. To avoid improper payments, request and analyze hospice election statement addendums for these enrollees.

Review the Acute Care Hospital Inpatient Prospective Payment System educational tool for more information:

We don’t pay for services given to palliate or manage a terminal illness and related conditions. Services should be provided under arrangements with the hospice provider.
We only pay for Part B outpatient services that are unrelated to the terminal illness and related conditions.

Claims, Pricers & Codes

Stem Cell Transplant National Coverage Determination: Reprocessing Certain Part A Claims

Certain Part A claims for the Allogeneic Hematopoietic Stem Cell Transplantation for Myelodysplastic Syndrome National Coverage Determination were incorrectly denied. Medicare Administrative Contractors will adjust claims that meet the following criteria:

Type of bill 13X
Date of service From Date on or after July 1, 2025
HCPCS code 38240 or 38241

You don’t need to take any action.

Medicare Part B Drug Pricing Files & Revisions: April Update

Learn about quarterly updates to the following average sales price and not otherwise classified pricing files:

April 2026
January 2026
October 2025
July 2025
April 2025

See the instruction to your Medicare Administrative Contractor (PDF).

Events

Quarter 4 FY 2025 PEPPER for Short-Term Acute Care Hospitals Webinar – April 7

Tuesday, April 7 from 1–2 pm ET

Join CMS to review the Quarter 4 FY 2025 Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) for short-term acute care hospitals. The session will provide participants with guidance on navigating the recent changes, including a review of the reports published in March 2026.

Prior to the webinar, send your questions to CMS_CBRPEPPER@cms.hhs.gov.

MLN Matters® Articles

Hospital Outpatient Prospective Payment System: April 2026 Update

Learn about updates (PDF), effective April 1, 2026:

New COVID-19 monoclonal antibody products and administration codes
New proprietary laboratory analyses codes and Hospital OPPS device categories
Status indicator revisions and ambulatory payment classification assignments
Drugs, biologicals, and radiopharmaceuticals
Skin substitute products

Publications & Multimedia

CMS Burden Reduction Conference Videos

Watch videos from the 2026 CMS Burden Reduction Conference.

This year’s conference featured a keynote address from CMS Administrator Dr. Mehmet Oz, opening remarks from CMS Chief Operating Officer and Deputy Administrator Kim Brandt, closing remarks from CMS Center for Medicare Director, Deputy Administrator, and HHS Chief Counselor Chris Klomp, and panel discussions focused on:

Increasing transparency in health care
Transforming chronic care
Using technology and AI tools to empower clinicians and patients

Medicare Coverage of Diabetes Supplies – Revised

CMS clarified (PDF) that we cover diabetes supplies during an inpatient stay under Medicare Part A.

From Our Federal Partners

VA Family Member Programs: Updated Guidance for Decision Reviews & Appeals

Veterans Affairs (VA) updated guidance for providers who disagree with decisions related to care delivered under the following family member programs:

Civilian Health and Medical Program of the Department of Veterans Affairs
Spina Bifida Health Care Benefits Program
Children of Women Vietnam Veterans Health Care Benefits Program
Camp Lejeune Family Member Program

If your claim is denied or you disagree with VA’s decision, you may submit new evidence through a supplemental claim, request a higher-level review, or file an appeal to the Board of Veterans’ Appeals. You may use only one option at a time.

The updated guidance clarifies what information and supporting documentation you need to submit a review or file an appeal, which helps avoid processing delays.

Visit the Provider Decision Reviews & Appeals–Family Member Care webpage for required forms and instructions. Providing complete information the first time helps minimize administrative delays and supports timely payment resolution.

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