04/14/2026

CMS-Medicare

Recent Oncology Related Articles

PC-Print April 2026 DP1 Updated CARC and RARC are Now Available

An updated PC-Print April 2026 DP1 is now available for download. 

Users need to install the Full Install version and then run the (DP1), to update the Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC).   

CMS Launches First Wave of HealthTech Ecosystem Tools, Fast-Tracking a Fully Digital, Patient-Centered Health System

A major leap forward in modernizing America’s healthcare system was announced during the Centers for Medicare & Medicaid Services (CMS) HealthTech Ecosystem Live! First Wave Launch event, which brought together CMS infrastructure, a new Medicare App Library, and an initial set of patient-facing applications to move the nation beyond clipboards, fax machines, and repetitive paperwork into a seamless, digital-first era.

Since calling on industry last year to help build a modern digital health ecosystem, more than 700 organizations have pledged support. Now, that commitment has evolved into real-world progress by hundreds of companies.

“For too long, Americans have navigated a health system that lags behind the technology they use everywhere else,” said CMS Administrator Dr. Mehmet Oz. “Today, CMS is bringing healthcare into the modern era—aligning innovators to deliver solutions that make care easier, more connected, and more personalized.”
CMS highlighted tools from more than 50 companies, many of which are already accessible or will be available to the public soon. These efforts represent the first real-world implementation of a connected digital health ecosystem, where patients can access, share, and use their health information through trusted applications.

As part of the event, interoperable digital tools were introduced intended to streamline care and improve the patient experience. Highlights included:

• Digital data access and check-in (“Kill the Clipboard”), allowing patients to securely share information with a simple scan on their phone.
• Personalized health applications, offering tailored guidance on nutrition, wellness, and chronic disease management—extending care beyond clinic walls.

By rallying industry around shared standards for identity, security, and interoperability, CMS is establishing the foundation for scalable innovation across the ecosystem. This approach reduces administrative burden, accelerates innovation, and supports a more connected, value-driven health system. It also strengthens CMS’ commitment to putting patients in control of their data and replacing outdated processes with modern digital tools.

The First Wave Launch marks a significant step toward a fully digital, patient-centered health system—demonstrating how coordinated infrastructure and private-sector innovation can deliver simpler, more connected experiences for patients.

For more information on CMS’ HealthTech Ecosystem, visit: 

https://www.cms.gov/priorities/health-technology-ecosystem/overview 

CMS Proposes Major Reforms to Speed Up Patient Access to Drugs, Increase Transparency, and Reduce Administrative Burden

Proposed rule would require faster prior authorization decisions, expand electronic prior authorization to drugs, and increase transparency across federal programs

 The Centers for Medicare & Medicaid Services (CMS) is proposing changes to slash long waiting periods for drugs, reducing barriers to timely access to critical treatments. The Interoperability Standards and Prior Authorization for Drugs proposed rule would advance sweeping reforms to modernize prior authorization for drugs by establishing clear decision deadlines for impacted payers – no later than 24 hours for urgent requests and 72 hours for standard requests – and increasing transparency through full disclosure of claims denials and appeals outcomes.

“Last year, we got 80 percent of the insurance industry to agree to eliminate prior authorization for common medical services such as diagnostic imaging, physical therapy, and outpatient surgery,” Health and Human Services Secretary Kennedy said. “This rule builds on that agreement by making it easier for patients to get the medications they need by minimizing delays and enabling real-time decisions.”

“Patients should not have to wait days or weeks for approval to start the medication their doctor prescribed,” said CMS Administrator Dr. Mehmet Oz. “This proposal moves prior authorization into the digital age, replacing fax machines and fragmented systems with real-time electronic workflows. We are standardizing the process, increasing transparency, and ensuring providers can focus on caring for patients instead of navigating red tape.”

Building on CMS’ 2024 Interoperability and Prior Authorization final rule, which addressed prior authorization for non-drug items and services, this proposal aims to ensure patients experience the same streamlined process for medications as other covered services.

The rule would expand electronic prior authorization requirements to include drugs, aligning processes across Medicare Advantage, Medicaid, the Children’s Health Insurance Program (CHIP), Qualified Health Plans (QHP) issuers on the Federally-facilitated Exchanges, and Small Group Market QHPs on the Federally-facilitated Small Business Health Options Program (FF-SHOP).

Impacted payers would also be required to publicly report prior authorization metrics for drugs, including:

• Approval and denial rates;
• Appeal outcomes; and
• Decision timeframes.

In addition, plans would report Application Programming Interface (API) usage metrics to CMS, allowing the agency to monitor adoption and performance of electronic systems. These measures would give patients, providers, and policymakers clearer insight into how consistently and efficiently prior authorization requests are handled. Public reporting would increase accountability and make it easier to compare how plans handle prior authorization decisions.

The rule also proposes adopting Fast Healthcare Interoperability Resources (FHIR®)-based standards to replace the outdated X12N 278 transaction standard currently used by a minority of health plans. This would enable real-time electronic workflows – including streamlined submission of clinical documentation – reducing administrative burden and improving speed and accuracy.  

The proposed rule would additionally:

• Update health IT standards and implementation guides to align with current versions adopted by ONC for HHS use;
• Expand existing interoperability requirements to small group market QHP issuers on the FF-SHOP; and
• Add a regulatory definition for “Failure to Report” to strengthen CMS’ oversight authority under the Open Payments program.

Finally, CMS is seeking public input through five Requests for Information on:

• Improving electronic event notifications for care coordination;
• Strengthening health care cybersecurity and system resilience;
• Enhancing oversight of payer APIs;
• Streamlining step therapy processes; and
• Improving prior authorization for laboratory tests and durable medical equipment, prosthetics, orthotics, and supplies.

CMS proposes compliance dates generally beginning in 2027, ensuring patients see improvements as quickly as possible.

To view the proposed rule on the Federal Register, visit: https://www.federalregister.gov/public-inspection/2026-07205/medicare-and-medicaid-programs-patient-protection-and-affordable-care-act-interoperability-standards.

To view the fact sheet, visit: https://www.cms.gov/newsroom/fact-sheets/2026-cms-interoperability-standards-prior-authorization-drugs-proposed-rule

CMS Rule Phases Out Fax Machines, Snail Mail to Save Taxpayers $781.98 Million a Year

The Centers for Medicare & Medicaid Services (CMS) is slashing wasteful spending and antiquated paperwork by swapping out faxing and mailing for streamlined electronic transactions. This action lets providers spend less time on administrative hassle and more time caring for patients.

The Administrative Simplification; Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures Final Rule is projected to save the healthcare industry roughly $781 million annually by establishing national standards for the electronic exchange of clinical documentation used to support health care claims. The rule also adopts standards for electronic signatures to ensure secure, authenticated transmission of this information. 

“The 1980s called, and they want their fax machines back,” said CMS Administrator Dr. Mehmet Oz. “The futuristic medical breakthroughs we’ve achieved, like augmented reality glasses that give surgeons X-ray vision, shouldn’t have to coexist with administrative systems that often lag decades behind. This new rule will modernize American healthcare by standardizing electronic claims attachments and enabling secure electronic signatures. Because every minute providers save on paperwork is another minute they can spend caring for patients.”

Historically, providers have relied on outdated manual methods to submit additional claims-related documentation requested by health plans, including medical records, X-rays, clinical notes, telemedicine visit documentation, and laboratory results - all of which cause delays and unnecessary costs. The standards finalized today establish a consistent, easy-to-use electronic framework for transmitting this documentation, improving efficiency across the entire healthcare system.

The standards adopted in this rule apply to Health Insurance Portability and Accountability Act (HIPAA)-covered entities, including health plans, healthcare clearinghouses, and healthcare providers that conduct electronic transactions.

The rule is effective on May 26, 2026 [60 days after publication in the Federal Register]. Covered entities must comply by May 26, 2028 [24 months of the effective date]. 

To view the final rule fact sheet, visit: https://www.cms.gov/newsroom/fact-sheets/administrative-simplification-adoption-standards-health-care-claims-attachments-transactions.

For more information, visit: https://www.cms.gov/priorities/key-initiatives/burden-reduction/administrative-simplification/hipaa/events-latest-news.

To view the final rule, visit https://www.federalregister.gov/d/2026-05676

Hospital Price Transparency: Enforcement of 2026 Requirements Starts April 1 

Enforcement of new and updated Hospital Price Transparency (HPT) requirements finalized in the CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule starts April 1, 2026. Make sure your hospital’s machine-readable file conforms to these requirements. See the updated HPT (PDF) fact sheet to learn more. 

CMS has resources to help hospitals understand and comply with the new requirements:

• CY 2026 OPPS and ASC Final Rule – HPT Policy Changes fact sheet
• HPT: Reviewing the CY 2026 OPPS and ASC Payment System Final Rule (PDF) webinar slides
• HPT FAQs (PDF)

CMS to Lower Drug Costs & Improve Care by Extending Deadline for GENEROUS Model Application 

CMS extended the application deadline for prescription drug manufacturers to apply to the GENErating cost Reductions fOr U.S. Medicaid (GENEROUS) Model—a landmark Innovation Center initiative designed to lower drug spending in Medicaid, improve quality of care and health outcomes by increasing access to critical medications, and strengthen the Medicaid program overall. The extension from March 31 to April 30, 2026, will provide interested drug manufacturers more opportunity to join the model. 

More Information:

• Full press release
• GENEROUS Model webpage
• Request for Applications for drug manufacturers (PDF)

Clinical Diagnostic Laboratories: Get Ready to Report Starting May 1 

Are you an independent laboratory, physician office laboratory, or hospital outreach laboratory that meets the definition of an applicable laboratory under the Clinical Laboratory Fee Schedule (CLFS)? If so, you must report data from May 1 – July 31, 2026, based on an updated data collection period of January 1 – June 30, 2025, including:

• Applicable HCPCS codes (ZIP)
• Associated private payor rates 
• Volume data 

For more information, visit the CLFS Reporting webpage.

Hospital Price Transparency: Get Guidance on New Requirements

CMS updated the Hospital Price Transparency FAQs (PDF) and posted new FAQs on Encoding Algorithms with Example Scenarios (PDF) to provide additional information on implementation of the CY 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center final rule.

Visit the Resources webpage for more information.

Integrated Outpatient Code Editor Version 27.1

CMS posted the April 2026 Integrated Outpatient Code Editor files. Learn about claims processing changes effective April 1, 2026.

See the instruction to your Medicare Administrative Contractor (PDF). 

Medicare Coverage Determination Process

The National Coverage Determination (NCD) Dashboard has been updated to reflect current lists of open NCDs, finalized NCDs, pending Transitional Coverage for Emerging Technologies (TCET) topics, and accepted NCD requests. https://www.cms.gov/files/document/ncddashboard.pdf