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All articles and reminders · Medicare & Medicaid Sweep

Published November 4, 2026 · Reporting window October 25–31, 2026, Pacific. Later developments are labelled. Source coverage is incomplete; the complete reports describe the limitations.

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16 articles and reminders, grouped by category.

Medicare & Medicaid Sweep

Higher-priority matters

Billing & payment 3 articles and reminders

Billing & paymentMedicare & Medicaid SweepNew in this edition

CMS increases the dialysis base rate and changes low-volume, home-training and quality policies for 2027

CMS set the 2027 Medicare dialysis base rate at $297.52 per treatment and revised low-volume, pediatric, home-training and quality policies. Eligible facilities seeking the 2027 low-volume adjustment face a December 31, 2026 attestation date; individual payment effects depend on facility circumstances.

High priority · Nov 4, 2026 editionRead story →

Billing & paymentMedicare & Medicaid SweepNew in this edition

2027 SNF consolidated-billing update

On October 26, 2026, CMS issued Transmittal 14003 (CR 14658) for the 2027 annual skilled nursing facility consolidated-billing update. It states a January 1, 2027 effective date and January 4 implementation date, and directs contractors to use the new A/B MAC (A) and (B) SNF coding files for applicable 2027 dates of service. The transmittal alone does not establish individual code changes or actual file postings.

Medium priority · Nov 4, 2026 editionRead story →

Billing & paymentMedicare & Medicaid SweepUpdated

2027 physician fee-schedule database instructions

On October 26, 2026, CMS issued Transmittal 14026 (CR 14618), rescinding and replacing R13960 and consolidating contractor instructions for the January, April, July and October 2027 Medicare Physician Fee Schedule database releases. Contractors must be prepared to retrieve up to three replacement payment datasets per release if corrections are required. For the April, July and October updates, contractors must give providers 30 days’ notice before implementing changes and adjust claims brought to their attention, without searching files to retract payment or retroactively pay already paid claims. This is not a provider filing deadline and does not establish that any replacement files were issued.

Medium priority · Nov 4, 2026 editionRead story →

Coverage & clinical policy 1 articles and reminders

Provider operations 8 articles and reminders

Provider operationsMedicare & Medicaid SweepNew in this edition

Exchange eligibility verification proposal

HHS and CMS proposed changes to Exchange eligibility verification, annual redeterminations and enrollment timing in a rule published October 27. The executive summary describes circumstances in which an Exchange generally could not authorize advance premium tax credits and cost-sharing reductions for an otherwise eligible applicant while specified eligibility inconsistencies remain unresolved, subject to a stated family-size special-enrollment exception; other inconsistencies are treated differently. Comments must be received by November 27, 2026, for assured consideration. This is a proposal, not a final rule; the full applicability schedule and all exceptions remain to be reviewed.

Medium priority · Nov 4, 2026 editionRead story →

Provider operationsMedicare & Medicaid SweepNew in this edition

SNF quality refresh and January preview

CMS says its October skilled nursing facility quality-data refresh is available, with older Medicare Spending Per Beneficiary data remaining in place. CMS had already announced the spending-data delay in July. Separately, an October 15 notice identifies November 14 for review of January 2027 preview reports, subject to CMS's review and data-correction rules.

Medium priority · Nov 4, 2026 editionRead story →

Provider operationsMedicare & Medicaid SweepConditional reminder

Reminder: DMEPOS order and prior-authorization lists

The July 30 notice set October 28, 2026 as the general implementation date for its DMEPOS list updates. It adds 22 specified HCPCS codes to the face-to-face encounter and written-order-before-delivery list and separately adds eight specified codes to the required prior-authorization list. Prior authorization for specified upper-limb orthoses is phased, starting October 28 in California, Florida, Michigan and New York; later phases are January 26 and April 26, 2027. The date’s arrival does not itself establish actual implementation; exact codes, exceptions and later amendments remain open.

Medium priority · Nov 4, 2026 editionRead story →

Provider operationsMedicare & Medicaid SweepNew in this edition

DHCS behavioral-health state plan proposal

On October 29, 2026, California DHCS issued a revised public notice for proposed Alternative Benefit Plan State Plan Amendment 26-0034. DHCS says the proposal would clarify behavioral health treatment policy, including utilization-management controls, and support program integrity. The revised notice applies only to 26-0034; DHCS says the June 30 notice for Medicaid State Plan Amendment 26-0033 remains unchanged. The notice states a July 1, 2026 proposed effective date subject to CMS approval; it does not establish approval or identify the specific utilization controls.

Medium priority · Nov 4, 2026 editionRead story →

Provider operationsMedicare & Medicaid SweepConditional reminder

Reminder: Home health QRP reconsideration

CMS’s October 23 entry says noncompliance notices for agencies determined noncompliant with CY 2027 annual payment update reporting requirements were placed in iQIES My Reports on October 23. An agency receiving a noncompliance letter may request reconsideration by 11:59 p.m. November 23, 2026, following its notice and CMS instructions. The cited page passage does not specify a time zone; the actual notice and instructions should be checked. This is a conditional reminder, not an in-week new announcement or a finding against any named agency.

Medium priority · Nov 4, 2026 editionRead story →

Provider operationsMedicare & Medicaid SweepUpdated

Prior-duty update: California rural health funding

On October 29, CMS said California had committed its full fiscal-year 2026 rural-health funding, more than $233 million, to programs across the state. This updates the same funding story as prior finding GC-2026-0329, which reported a $233,639,308.47 first-budget-period award and $219,133,495 put to work through July 31 based on earlier state-reported obligations. The October announcement should not be added to that award as separate new funding or treated as proof of disbursement to particular providers.

Medium priority · Nov 4, 2026 editionRead story →

Provider operationsMedicare & Medicaid SweepUpdated

Prior-duty update: Noridian A57079 R7

Noridian’s October 29 Jurisdiction E Part B notice reports an A57079 revision effective November 1, 2026. It says the Group 1 medical-necessity asterisk explanation specifies diagnosis M72.0 for CPT 20527 and 26341. This R7 notice follows the R6 conformity update described in our October 11 finding; the notice does not determine an individual claim’s medical necessity or payment. The current complete article and earlier R6 table were not reviewed here.

Medium priority · Nov 4, 2026 editionRead story →

Provider operationsMedicare & Medicaid SweepUpdated

Prior-duty update: Noridian A60217 R2

Noridian’s October 29 Jurisdiction E notice says revision R2 to billing and coding article A60217 adds 0665U to Group 1 for specified liver-disease biomarker testing, effective October 1, 2026. Noridian cautions that a code’s inclusion does not automatically mean coverage. This is a potential update to the October 11 finding GC-2026-0134; compare the current article and LCD with the earlier version before treating it as a material change. The current complete article, LCD and registry details remain open.

Medium priority · Nov 4, 2026 editionRead story →

More matters and continuing watch

Provider operations 2 articles and reminders

Audits & program integrity 2 articles and reminders

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