April 2026 Newsletter

CMS Phasing Out Fax and Mail, Impacting Revenue Cycle Management Services

Under the Administrative Simplification; Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures Final Rule, CMS plans to phase out fax machines and “snail mail”. The rule goes into effect on May 26, 2026 and covered entities must comply by May 26, 2028 [1].  

What this means for your team: If this change is significantly disruptive for your team, consider new options in revenue cycle efficiency like partnering with a revenue cycle billing and coding vendor.

HCPCS Quarterly Update Available

CMS has made the medical coding April 2026 quarterly update available for download. It can be accessed under file name April 2026 Alpha-Numeric HCPCS File (ZIP) on the CMS website [2].  

Radiation Oncology Faces Challenges Due to New Revenue Cycle Billing Codes

The January 1 overhaul of radiation therapy codes, including deleting code 77014 and the addition of a separate code for professional components of imaging use, has been placing increasing burden on physicians and potentially disrupting physician billing services. The American Society of Radiation Oncology reports that physicians are facing a range of challenges because of the new codes, which poses a potential and immediate threat to cancer care in the US [3].  

Hospital Billing Information for CAHs Reprocessing Claims with Reassigned Billing Rights

CMS has published a notice to Method II Critical Access Hospitals. These hospitals should bill for facility and professional outpatient services exclusively when practitioners or physicians reassign billing rights to the hospital. Additional information on reassignment benefits to CAHs is available in the Information for CAHs booklet [4].

OIG Releases New Program Guidance for for MAOs

The Office of the Inspector General has released updated Medicare Advantage Compliance Program guidance. It applies to Medicare Advantage Organizations, delegated providers, and first-tier, downstream, and related entities. The new guidance covers enforcement of audits, investigations, and evaluations [5].  

Coding Update Specifics for SNF HCPCS Codes Released

CMS has published a document covering coding updates including terminated codes, added codes, chemotherapy, and the angiography, lymphatic, venous and related procedures category. It is effective July 1, 2026, and applies to SNFs and other providers billing MACs for services, impacting medical coding in USA [6].  

Hospital Expenses Increased 7.5% in 2025

The American Hospital Association Cost of Caring report found that hospital total spending rose 7.5%, largely due to patient volume increases, wage pressure, and increases in drug spending. Inpatient volumes alone rose 5.3% while outpatient increased 9.8%. This is accompanied by a 5% increase in hospital case mix, changes that should be of note to hospital revenue cycle leaders [7].  

What this means for your team: If your organization is caring for sicker patients in your case mix, it might be time to reevaluate your revenue cycle strategy. Start here.

Hospital Outpatient Prospective Payment System Updates for April

CMS released a medical billing update signaling the change of status indicator for HCPCS code Q5099 from E1 to K. The update also changes the CR release date, transmittal numbers, and transmittal link. It affects hospitals, physicians, and other providers billing Medicare Administrative Contracts for outpatient hospital services and is effective April 1, 2026 [8].

$15.8 Billion in HHS Budget Cuts Proposed by Trump Administration

According to the 2027 budget (released April 3), the current administration plans on cuts of $15.8 billion to the Department of Health and Human Services. The cuts would be accompanied by a restructuring of federal health bureaucracy, eliminating some agencies, and cutting $5 billion in programs the administration deems wasteful [9].  

What this means for your team: These cuts to CMS outreach and education increase the chance of billing errors and the possibility of denials. Your team should expect an increased risk of navigating Medicare compliance with decreased federal guidance. This is in combination with Medicaid cuts that are taking place this year, increasing uncompensated care and further decreasing operating margins. Academic medical centers should also be mindful of cuts to NIH and possible impacts to clinical trial billing.

Revision to National Coverage Determination for Renal Denervation for Hypertension

CMS released a change request revising National Coverage Determination 20.40. Place of service code 24 is now allowable for professional claims medical billing. Codes C1735 and C1736 will not be reimbursed. These changes are implemented as of April 6, 2026 and apply to physicians and hospitals [10].

Medicare Advantage and Part D Rule Finalized

CMS has published the final 2027 rule for Medicare Advantage and Part D. It enacts changes to supplemental benefits administration, star ratings, Part D coverage and other deregulatory provisions. It does not implement the Excellent Health Outcomes for All reward and is effective June 1 [11].