May 2026 Newsletter

Leading Health Systems Share Payoff of Revenue Cycle Investment

HCA Healthcare and Universal Health Services are publicly touting the benefits of their revenue cycle investments on earnings calls. They are framing them as a counter to “elevated denial and underpayment activity” and stress the benefits in Medicare Advantage scenarios in particular. UHS is also planning a rollout into behavioral health revenue cycle applications [1].  

What this means for your team: If your organization has been waiting for a signal that it’s time to invest in revenue cycle management services or hospital billing, take this as a clear one that this is where the market is headed.

Medicare Premiers Short-Term GLP-1 Bridge

CMS has announced that it is expanding access to some GLP-1 medications through a short-term demonstration. The demonstration starts July 1, 2026 and applies to Part D beneficiaries. It will operate outside of the beneficiary’s part D coverage, through a central processor for authorization, processing, and payments in medical billing [2].  

Open Payments Review Deadline: May 15

Covered recipients have until May 15, 2026 to review and dispute 2025 OpenPayments data before June publication. Review for this price transparency exercise is voluntary but the agency is strongly encouraging participation. It offers Quick Start guides for healthcare providers and teaching hospitals [2].  

The Payor-Provider AI Arms Race Heats Up

Becker’s takes a look at the revenue cycle battleground, examining a growing dynamic of payers automating denials at higher speeds while providers are trying to keep up. This article reviews provider perspectives, how payers have sped ahead, and offers advice for automation [3].  

What this means for your team: AI is becoming an indispensable tool for navigating the AI arms race in hospital revenue cycle. Start here to explore solutions that meet your medical coding outsourcing needs.

Clinical Diagnostic Lab Reporting Deadline in July

For hospitals billing on a 14X type bill, they should be aware of an approaching laboratory deadline. These hospitals likely meet the definition of an applicable laboratory under the Clinical Laboratory Fee Schedule (CLFS). CMS has provided resources on checking status before the hospital billing data reporting deadline of July 31, 2026 [2].  

MSSP Application Tool Materials Available

CMS has published the Medicare Shared Savings Program Application Toolkit to aid in preparation for the next application submission cycle. The agency will be accepting Shared Savings Program Applications beginning Jun 9, 2026 and running through noon ET on June 23 [2].  

OIG Audit Finds Sleep Apnea Products Complied with Medicare

A recent OIG audit found that CMS generally ensured that payments for PAP devices made to suppliers generally complied with Medicare billing requirements. The audit was performed because, in 2017, the Comprehensive Error Rate Testing Program determined that CPAP devices exhibited the second highest improper payment amount in the DMEPOS category [4].  

Streamlining Prior Authorization

CMS has announced its intent to work with health plans and certified EHR vendors to streamline the prior authorization process. The program involves electronic prior authorization requests with a goal of reducing burdens, improving information access and advancing interoperability [5].  

What this means for your team: The government is pushing for changes in prior authorization, meaning providers should be looking for partners in updating their strategies, especially since this impacts medical billing denials. Start here to learn more.  

Proposed Rule for IPPS and LTCHPPS

CMS has announced a proposed hospital revenue cycle rule that would revise the hospital Inpatient Prospective Payment System. It would also make changes to Medicare graduate medical education for teaching hospitals, update the payment policies and annual payment rates for the Medicare Prospective Payment System for services provided by long-term care hospitals, and make updates for certain quality programs [6].  

United Healthcare Cutting Prior Auth for 30% of Services 

UnitedHealthcare has announced that it’s reducing prior authorizations for 30% of its services. The USA medical billing cuts will happen by the end of 2026, with UnitedHealthcare rolling back authorization for some outpatient surgeries, outpatient therapies, chiropractic care, and diagnostic tests like echocardiograms [7].