MLN Connects Newsletter for March 5, 2026

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Date
2026-03-05
Title
In This Edition: DMEPOS | GENEROUS Model | Opioid Use Disorder
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News

Compliance

Claims, Pricers & Codes

Publications & Multimedia

 

News

DMEPOS: Temporary Enrollment Moratorium on Medical Supply Companies 

On February 27, CMS implemented a temporary nationwide enrollment moratorium on DMEPOS medical supply companies. The moratorium will remain in effect for 6 months and may be extended in 6-month increments. 

We’ll deny any initial enrollment or change in majority ownership applications submitted that violate requirements until the moratorium ends.

More Information:

 

CMS to Lower Drug Costs & Improve Care by Extending Deadline for GENEROUS Model Application 

CMS extended the application deadline for prescription drug manufacturers to apply to the GENErating cost Reductions fOr U.S. Medicaid (GENEROUS) Model—a landmark Innovation Center initiative designed to lower drug spending in Medicaid, improve quality of care and health outcomes by increasing access to critical medications, and strengthen the Medicaid program overall. The extension from March 31 to April 30, 2026, will provide interested drug manufacturers more opportunity to join the model. 

More Information:

 

Laboratories: We’ve Transitioned to Paperless Operations

CMS completed the transition to a paperless system and no longer mails Clinical Laboratory Improvement Amendment (CLIA) certificates or paper fee coupons. Additionally, all CLIA certification and survey fees must be paid online; payments by paper check are no longer accepted.

Laboratories and providers that perform laboratory testing must have a valid email address on file to get electronic CLIA certificates, fee coupons, and other CMS communications. Without a valid email address, you may experience billing or certification issues. Note: This doesn’t apply to CLIA-exempt states or state licensure.

Need Help?

Visit the CLIA webpage for more information.

 

No-Pay Medicare Summary Notice Mailing Frequency Changed to Every 180 Days 

The frequency of No-Pay Medicare Summary Notices (MSNs) changed from every 120 days to every 180 days, effective January 1, 2026. Remind your patients that they can go digital to get their MSNs electronically. 

More Information:

 

Compliance

Opioid Use Disorder: Learn about Services to Help Your Patients Continue Treatment

In a report, the Office of Inspector General determined that buprenorphine—the most common medication used to treat opioid use disorder (OUD) in Medicare—can decrease both opioid use and overdose deaths, leading to improved outcomes. 

Medicare Part B covers many services that help your patients continue treatment for OUD for as long as reasonable and necessary. Visit the Opioid Treatment Programs webpage for more information.

 

Major Hip & Knee Replacement or Reattachment of Lower Extremity: Prevent Claim Denials 

In 2024, the improper payment rate for major hip and knee replacement or reattachment of lower extremity was 43.6%, with a projected improper payment amount of $546.7M. Learn how to bill correctly for these services. Review the Major Hip & Knee Replacement or Reattachment of Lower Extremity provider compliance tip for more information, including:

  • Billing codes
  • Denial reasons and how to prevent them
  • Documentation requirements
  • Medical review policies of 2-midnight rule
  • Resources

 

Claims, Pricers & Codes

National Correct Coding Initiative: April Update  

Get the National Correct Coding Initiative (NCCI) first quarter edit files effective April 1, 2026, on these Medicare NCCI webpages:

See the instruction to your Medicare Administrative Contractor (PDF)

 

Publications & Multimedia

2026 Medicare Part C and Part D Reporting Requirements & Data Validation – Revised

CMS revised the web-based training:

  • Updated the file for the 2026 Data Validation of Contract Year 2025 Medicare Part C and D Reporting Requirements data
  • Clarified the Part C and Part D reporting section timelines
  • Updated the email address for data validation questions

 


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