Navigate Shifting Reimbursement Criteria for Molecular Testing
At TELCOR, we’ve recently identified a notable shift in how molecular claims specifically associated with CPT code 87798, are being processed by...
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The Centers for Medicare & Medicaid Services opened a Request for Information (RFI) asking for public comment about how to modernize Medicare Advantage (MA).
The RFI follows a proposed rule, issued on Nov. 25, 2025, that would revise the MA program and the Medicare Cost Plan Program, along with the Medicare Prescription Drug Benefit Program (Part D), for contract year 2027. The rule would remove 12 unique measures to create a Star Ratings system, intended to be more focused and better at measuring and incentivizing quality improvements. Additionally, the rule would offer a new special enrollment period (SEP) for provider terminations and codify related policy regarding SEP utilization.
CMS invites public feedback on MA modernization, including ways to improve competition, refine risk adjustment, and align quality incentives. The RFI seeks public input on whether CMS could meet its objectives through either a time-limited test model under the CMS Innovation Center’s authority or potential program-wide regulatory changes.
The proposed rule will be open for public comment for 60 days, until Jan. 24, 2026.
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Quality Payment Program Claim Adjustment Applied to Correct Conversion Factor
The Centers for Medicare & Medicaid Services has found a system issue related to the 2026 Medicare Physician Fee Schedule conversion factors.
Updated CDLT Data Reporting Period to Begin May 1
Effective May 1, clinical diagnostic laboratories will be required to follow new data reporting requirements for clinical diagnostic laboratory tests...