News
- DMEPOS Competitive Bidding Program: Registration & Bid Window Dates for Round 2028
- CMS Finalizes New Mandatory Drug Payment Model to Deliver Lower Drug Prices for Beneficiaries in Original Medicare Part B
- New Regulations Make It Easier to Find, Compare & Report Health Care Pricing and Coverage Information
- Alabama: Nearly $55M to Expand Rural Maternal and Emergency Care, Cancer Screening & Health Care Workforce
- North Carolina: $20M to Expand Telehealth Access & Upgrade Health Care Technology
- South Dakota: $7.2M to Expand Ambulance-Based Telemedicine & Upgrade Emergency Communications
- HETS: Verify Email by December 1 to Avoid Rejected Eligibility Requests
- Quality Payment Program: 2027 Virtual Group Election Period – Submit by December 31
Compliance
- Skilled Nursing Facilities: Accurately Report Your Related-Party Costs
- Patient Lifts: Prevent Claim Denials
Claims, Pricers & Codes
- HCPCS Application Summaries & Coding Determinations: Drugs & Biologicals
- RARCs, CARCs, Medicare Remit Easy Print & PC Print: October Update
Events
MLN Matters® Articles
- DMEPOS Fee Schedule: October 2026 Quarterly Update
- Hospital Outpatient Prospective Payment System: October 2026 Update
News
DMEPOS Competitive Bidding Program: Registration & Bid Window Dates for Round 2028
CMS announced the bidding timeline for Round 2028 of the DMEPOS Competitive Bidding Program:
- December 1, 2026: Bidder registration window opens
- January 5, 2027: Bid window opens
Visit the Competitive Bidding Implementation Contractor website for more information, including:
We encourage bidders to review all these materials for guidance needed to submit complete bids by the close of the bid window. Read the full news article for more information.
CMS Finalizes New Mandatory Drug Payment Model to Deliver Lower Drug Prices for Beneficiaries in Original Medicare Part B
CMS is finalizing a groundbreaking drug payment model to address the increasingly expensive cost of drugs in Original Medicare Part B while preserving or enhancing Medicare beneficiaries’ quality of care. Building upon the Trump Administration’s ongoing efforts to reduce drug costs for Americans, the Global Benchmark for Efficient Drug Pricing (GLOBE) Model will test whether a new rebate formula for certain drugs in the Medicare Part B Drug Inflation Rebate Program reduces costs for Original Medicare beneficiaries and the Medicare program while preserving quality of care.
The GLOBE Model will operate for 5 years, beginning January 1, 2027, and ending March 31, 2032, with pharmaceutical manufacturer rebate invoicing and reconciliation continuing until March 31, 2034. The model will apply to Medicare beneficiaries who reside in a randomly selected subset of geographic areas, encompassing approximately 25% of total Medicare beneficiaries who have Original Medicare as their primary coverage. Selected beneficiaries who will be impacted by the model may begin to see reduced out of pocket costs beginning April 1, 2027.
More Information:
New Regulations Make It Easier to Find, Compare & Report Health Care Pricing and Coverage Information
HHS, through CMS, announced that Americans will have access to more reliable, accessible, and actionable information about what their health coverage includes and what they are likely to pay before receiving care under new regulations that strengthen federal health care price transparency requirements. The actions taken to create a more transparent health care marketplace also ensure employers can make more informed decisions; researchers can better understand health care markets; and innovators can build better tools.
Updates to the Transparency in Coverage (TiC) rules, finalized by CMS, in partnership with the Departments of Labor and the Treasury, build on the historic health care price transparency rules established during President Trump’s first term. The final rules improve the underlying health care pricing data by reducing duplicative and unnecessary information, providing more context about in-network prices, increasing available out-of-network pricing information, and strengthening accountability for the completeness and accuracy of published data. Reporting frequency for pricing information will change from monthly to quarterly, maintaining meaningful transparency while lowering administrative burden.
More information:
- Full press release
- TiC final rules
- TiC Final Rules fact sheet
- Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Health Care Pricing Information executive order
Alabama: Nearly $55M to Expand Rural Maternal and Emergency Care, Cancer Screening & Health Care Workforce
This federal investment will support 34 grants including maternal care networks and increase access to cancer screening across Alabama.
The Trump Administration announced that nearly $55 million in federal funding is being delivered to strengthen the rural health care workforce and expand access to maternal, emergency, and preventive care for Alabamians through the Rural Health Transformation Program. The investment will support 34 grants to health care providers and institutions serving rural communities across Alabama.
Read the full press release.
North Carolina: $20M to Expand Telehealth Access & Upgrade Health Care Technology
This federal investment will help expand virtual care, upgrade electronic health records, strengthen cybersecurity, and equip rural providers with new technology to better serve patients.
The Trump Administration announced that a $20 million investment is being delivered to upgrade health care technology and expand access for patients across rural North Carolina through the federal Rural Health Transformation Program. This funding will support North Carolina’s Rural Health Innovation Fund, making funding available to eligible providers for technology upgrades and other digital health care advancements.
Read the full press release.
South Dakota: $7.2M to Expand Ambulance-Based Telemedicine & Upgrade Emergency Communications
This federal investment will help South Dakota's rural ambulance crews reach patients faster, share critical health data with hospitals, and respond to emergencies with modern technology.
The Trump Administration announced $7.2 million in Rural Health Transformation Program funding to modernize emergency medical services for South Dakota. This investment will provide first responders with modern telemedicine tools, expanded training, and faster access to patient data, helping them respond to emergencies and better connect rural patients with care across South Dakota.
Read the full press release.
HETS: Verify Email by December 1 to Avoid Rejected Eligibility Requests
If you use HIPAA Eligibility Transaction System (HETS) 270/271 to check Medicare eligibility through a software vendor, billing company, electronic health record (EHR) system, practice management system, or electronic data interchange (EDI) clearinghouse, make sure the email address on your HETS EDI Enrollment is correct by December 1, 2026. If you get a notification from your clearinghouse about an email delivery failure, or you don’t get a monthly transaction count report after submitting your HETS EDI enrollment, update your email address through your Medicare Administrative Contractor (MAC) to avoid disruption (your billing company, EHR vendor, or clearinghouse can’t make this change for you).
If your HETS email fails to deliver for 3 consecutive months — October 1, November 1, and December 1, 2026, HETS will suspend your HETS EDI enrollment and reject all eligibility requests submitted for your NPI. HETS will return an error until you correct your email address through your MAC.
Quality Payment Program: 2027 Virtual Group Election Period – Submit by December 31
If you’re interested in forming a virtual group for the 2027 Merit-based Incentive Payment System (MIPS) performance year, the election period started on October 1, 2026. To form a virtual group, submit your election to CMS at MIPS_VirtualGroups@cms.hhs.gov by December 31, 2026.
More Information:
Compliance
Skilled Nursing Facilities: Accurately Report Your Related-Party Costs
In a report, the Office of Inspector General found that some skilled nursing facilities (SNFs) didn’t comply with Medicare requirements for reporting related-party costs. These SNFs failed to report related parties on their Medicare Cost Reports or reported the costs inaccurately, resulting in overstated costs to the Medicare Program.
Review the SNF Billing Reference educational tool to find out:
- Why related-party costs must be reported accurately
- How to accurately report these costs and required documentation
Patient Lifts: Prevent Claim Denials
In 2024, the improper payment rate for patient lifts was 25.4%, with a projected improper payment amount of $3 million. Learn how to bill correctly for these services. Review the Patient Lifts provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Documentation requirements
Claims, Pricers & Codes
HCPCS Application Summaries & Coding Determinations: Drugs & Biologicals
CMS published the 2026 HCPCS Application Summary for Quarter 3, 2026 Drugs and Biologicals. Visit the HCPCS Level II Coding Decisions webpage for more information.
RARCs, CARCs, Medicare Remit Easy Print & PC Print: October Update
Get updated remittance advice remark codes (RARCs) and claim adjustment reason codes (CARCs). Watch for software updates if you use Medicare Remit Easy Print or PC Print.
More Information:
- Medicare Claims Processing Manual, Chapter 22, sections 40.5, 60.2, and 60.3
- Instruction to your Medicare Administrative Contractor (PDF)
Events
HCPCS Public Meeting: November 2–3
Monday, November 2 – Tuesday, November 3 from 9 am – 5 pm ET
Attend a hybrid public meeting for the second biannual 2026 HCPCS coding cycle. Visit HCPCS Level II Public Meetings for more information, including:
- Meeting materials
- Guidelines
MLN Matters® Articles
DMEPOS Fee Schedule: October 2026 Quarterly Update
Learn about updates (PDF):
- Added and deleted HCPCS codes, effective October 1, 2026
- New fee schedule amounts, effective October 1, 2026
- Level II HCPCS changes for continuous glucose monitors and external insulin infusion pump supplies, effective January 1, 2028
Hospital Outpatient Prospective Payment System: October 2026 Update
Learn about updates (PDF):
- CPT proprietary laboratory analyses coding changes
- New Category III CPT and HCPCS codes
- Ambulatory payment classification assignment, descriptor, and status indicator changes
- Drugs, biologicals, and radiopharmaceuticals
- Skin substitute products
Qualifying non-opioid treatments for pain relief
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