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02/17/2026

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Practices who are using 340B Acquired Drugs - You can find information on the Mandatory Drug Acquisition Cost Survey below.

The Outpatient Prospective Payment System (OPPS) Drug Acquisition Cost Survey (ODACS) is live. Hospitals paid under OPPS and listed on this ODACS provider table (PDF) must submit their drug acquisition cost data to CMS by March 31 at 11:59 pm ET.

Outpatient Prospective Payment System (OPPS) Drug Acquisition Cost Survey | CMS

Medicare Outpatient Prospective Payment System (OPPS) Drug Acquisition Cost Survey Frequently Asked Questions

Hospitals: Submit Data for OPPS Drug Acquisition Cost Survey by March 31

FY 2025 Medicare Fee-for-Service Improper Payment Rate

CMS reported the national Medicare Fee-for-Service (FFS) improper payment rate in the FY 2025 HHS Agency Financial Report (section 3, Payment Integrity Report).

The 2025 national Medicare FFS improper payment rate is 6.55%, or $28.83B in improper payments. Most of these improper payments fall into 2 categories:

  1. Insufficient documentation
  2. Documentation provided didn’t sufficiently demonstrate medical necessity

See the FY 2025 Improper Payments fact sheet for more information.

FY 2025 Medicare Fee-for-Service Improper Payment Rate

CMS Proposes 2027 Medicare Advantage and Part D Payment Policies to Improve Payment Accuracy & Sustainability 

CMS released the CY 2027 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and MA and Part D Payment Policies (the CY 2027 Advance Notice). This annual release proposes routine and technical updates that ensure MA and Part D payments are accurate. If finalized, the proposed policies are projected to result in a net average year-over-year payment increase of 0.09%, or over $700M in MA payments to plans in CY 2027. This expected increase includes consideration of the various elements that impact MA payments, such as growth rates of underlying costs, 2026 Star Ratings for 2027 quality bonus payments, and risk adjustment updates. CMS also expects that the CY 2027 Advance Notice’s proposed policies will promote even greater payment accuracy, maintain beneficiary choice, help ensure affordable coverage for Medicare beneficiaries, and enable an even more stable MA program in the long run.

More Information:

CMS Proposes 2027 Medicare Advantage and Part D Payment Policies to Improve Payment Accuracy & Sustainability

CMS Announces Selection of Drugs for Third Cycle of Medicare Drug Price Negotiation Program, Including First-Ever Part B Drugs

CMS announced the selection of 15 high-cost prescription drugs covered under Medicare Part D and, for the first time, drugs payable under Medicare Part B for the third cycle of the Medicare Drug Price Negotiation Program. CMS also selected one previously negotiated drug for the program’s first renegotiations. Negotiations with participating drug companies will occur in 2026 and any negotiated and renegotiated prices will become effective January 1, 2028. 

More Information:

 CMS Announces Selection of Drugs for Third Cycle of Medicare Drug Price Negotiation Program, Including First-Ever Part B Drugs

Remote Patient Monitoring: Use & Bill Correctly 

In a report, the Office of the Inspector General recommended additional oversight of remote patient monitoring in Medicare. About 43% of enrollees who received remote patient monitoring didn’t receive all 3 components, raising questions about whether it’s being used as intended.

Learn how to correctly use and bill for remote patient monitoring:

Remote Patient Monitoring: Use & Bill Correctly

Updated Telehealth FAQs

The Consolidated Appropriations Act, 2026 signed into law on February 3, 2026, extends Medicare telehealth flexibilities through December 31, 2027. To learn more, refer to the CMS Telehealth FAQ – Updated 02/024/2026. 

Only two weeks until the
2026 CMS Burden Reduction Conference!

The 2026 CMS Burden Reduction Conference is two weeks away. We’ve announced an incredible list of speakers, including a keynote from CMS Administrator Dr. Mehmet Oz.

The conference will take place on February 25, 2026, from 9:00 AM–1:00 PM ET.

Register Now!

In-person attendance has reached capacity, but virtual participation is available.

Don’t miss a chance to hear from our remarkable speakers. Throughout the conference, participants will engage in practical, solution-focused discussions centered on reducing administrative burden, strengthening chronic care coordination, and improving the experience of both clinicians and patients. By highlighting real-world examples and shared learning across sectors, the CMS Burden Reduction Conference aims to support meaningful progress toward a more efficient, transparent, and patient-centered healthcare system.

Register for virtual attendance: https://bit.ly/4q3tIDk

For questions or additional information, please email burdenreduction@cms.hhs.gov.

If you've already registered, you can head to https://cmsburdenreductionconference.com/ or use the links provided in your confirmation email to review your registration. 

We’re looking forward to an informative and exciting day of ideas, discussions, and lessons learned. 

2026 CMS Burden Reduction Conference – February 25

CMS ACCESS Technology Initiative

CMS believes people with Original Medicare have limited access to technology-supported care services for managing their chronic conditions because of Medicare payment barriers.  Through ACCESS, CMS will test a new payment option that emphasizes outcomes over activities, enabling clinicians to offer innovative technology-supported care that improves patients’ health and complements traditional care.

Major Health Plans Join ACCESS Payer Pledge

What’s new: Major health payers representing 165 million Americans with Medicare Advantage, Medicaid and private health insurance plans pledged to adopt an outcomes-based payment structure aligned to the Medicare-focused ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model.

Why it matters: The pledge is an important step to alignment across Medicare, Medicaid, and commercial payers around payments for technology-supported care that incentivize flexibility in care delivery, coordination with primary care and clinicians and — most importantly — measurable improvements in patient health outcomes rather than volume of services.

What to expect: The ACCESS Model begins its 10-year performance period in July 2026; under the ACCESS Payer Pledge, payers commit to offering payment arrangements that align with core principles of the model by January 1, 2028.

The big picture: Payers’ voluntary alignment to ACCESS builds on earlier support from clinician and patient societies acknowledging the necessity of making technology-supported more accessible to all Americans, empowering them to meet their health goals and prevent or manage their chronic conditions; this is just the latest example of CMS using convening power to align stakeholders towards a common goal.

Additional details: Payers that have signed the pledge include Arkansas Blue Cross and Blue Shield, Blue Shield of California, Blue Cross and Blue Shield of Minnesota, Blue Cross Blue Shield of North Dakota, BlueCross BlueShield of Tennessee, CareFirst BlueCross BlueShield, Centene, Cigna, CVS Health, Devoted Health, Guidewell, Horizon Blue Cross Blue Shield of NJ, Humana, UnitedHealthcare.

CMS is developing a set of optional alignment resources for health plans, expected to be available later this year including:

  • Reference documents, such as a sample provider agreement structure and payment adjustment code
  • Standardized billing codes, including track-specific G-codes that may be used by any payer to support consistent administrative workflows
  • FHIR-based reporting infrastructure, enabling payers to align on CMS’ outcome measures and direct applicable providers to submit performance data through a CMS-hosted API, with CMS returning results to payers on a recurring basis for their own payment determinations

Payer organizations that are interested in joining the pledge and learning about available CMS resources may visit the model webpage and complete the interest form.

Find out more:

MLN Matters

To Review Recent LearnResource & MedLearn Matters Articles, CLICK HERE. 

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