08/18/2026

CMS-Medicare

Recent Oncology Related Articles

CY 2027 Medicare Physician Fee Schedule Proposed Rule

CMS issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2027.

The proposed rule also includes:

• CY 2027 PFS rate setting and conversion factor
• Strengthening Medicare ACO participation and accountability
• Medicare Shared Savings Program requirements
• Quality Payment Program proposals and requests for information (RFIs)
• Evaluation and management (E/M) visits:
• Accounting for overlap between stand-alone E/M visits and global periods
• Complexity add-on code
• Remote monitoring
• Comment solicitation on:
• Redesigning primary care to make America healthy again
• Strategies for improving global surgery payment accuracy
• Policies to improve care for chronic illness and behavioral health needs 
• Clinical Laboratory Fee Schedule payment and reporting requirements
• Medicare Prescription Drug Inflation Rebate Program
• Limiting Medicare coverage of certain individuals
• RFI on duplicate laboratory testing, imaging, and result sharing and interoperability

More Information:

• Full fact sheet
• CMS Proposes Transformational Medicare Reforms to Expand Accountable Care, Modernize Physician Payment & Shift from Sick Care to Healthcare press release 
• Medicare Shared Savings Proposals fact sheet
• Quality Payment Program fact sheet and policy comparison table

CMS Proposes New Requirements for Off-Campus Outpatient Departments of a Provider – Submit Comments by August 31 

CMS issued the CY 2027 Hospital Outpatient Prospective Payment System & Ambulatory Surgical Center Payment Systems proposed rule seeking to codify and implement Section 6225 of the Consolidated Appropriations Act, 2026, which prohibits Medicare payments for services provided by certain off-campus outpatient departments of a provider, effective January 1, 2028, unless certain requirements are met. The statute defines off-campus outpatient departments of a provider to mean provider-based departments that are not located on the campus of the provider or are not within the regulatorily-specified distance from a remote location of a hospital. 

To continue receiving payment after January 1, 2028, the statute requires affected providers to take the following actions for each off-campus outpatient department of a provider:

• Obtain and bill under a separate NPI 
• Submit an initial attestation demonstrating compliance with provider-based regulations within the prior 2 years of the date of service, as well as a subsequent attestation within a timeframe specified by the Secretary 

CMS encourages stakeholders to submit comments electronically at regulations.gov by August 31, 2026.

CMS Identity Management (IDM) Login Changes

If you have logged into the CMS IDM websites for Medicare Cost Report Electronic Filing (MCReF) or the Provider Statistical & Reimbursement Report (PS&R) system recently, you may have noticed a different login page. CMS has published information regarding the new IDM sign-in experience. This information has been posted on the following CMS webpages:

• CMS Intern and Resident Information System (IRIS)webpage
• CMS Medicare Cost Report Electronic Filing (MCReF)webpage
• CMS Part A Cost Report Audit & Reimbursementwebpage
• CMS Provider Statistical & Reimbursement Report (PS&R)webpage

CMS Medicaid Fraud War Room Stops More Than $203 Million in Improper Payments During First 88 Days

50 high-risk providers identified through coordinated federal, state enforcement actions

The Centers for Medicare & Medicaid Services (CMS) announced that enforcement efforts from its Medicaid Fraud War Room (MFWR) stopped more than $203 million in potentially improper Medicaid payments in just under 90 days, highlighting significant progress in protecting taxpayer dollars and strengthening Medicaid program integrity. Since its launch on April 23, the MFWR has coordinated actions against 50 unique, high-risk Medicaid providers identified through advanced data analytics and representing more than $203 million in Medicaid payments subject to federal exclusions and state enforcement efforts.

“Every dollar lost to Medicaid fraud is a dollar taken away from vulnerable Americans who rely on it,” said CMS Administrator Dr. Mehmet Oz. “In just under 90 days, the Medicaid Fraud War Room has proved that these losses aren’t inevitable and has shown Americans what we can accomplish with robust federal-state partnerships, advanced data analytics, and a real sense of urgency. We’ve made significant progress toward crushing waste, fraud, and abuse, but we’re not done yet. If you steal from Medicaid, we will track you down, cut you off, and work to ensure that every taxpayer dollar we spend funds quality care for eligible beneficiaries.”

To date, MFWR activities have resulted in:

• Forty-two Federal Notices of Intent to Exclude providers from federal healthcare programs were issued by the U.S. Department of Health and Human Services Office of Inspector General (OIG), representing approximately $160.7 million in Medicaid payments since January 1, 2025.
• Fifteen state enforcement actions were taken against providers based on MFWR referrals, representing approximately $46.2 million in Medicaid payments since January 1, 2025.
• Seven of these providers were subject to both federal and state action, meaning that 50 unique providers have been identified, representing approximately $203.3 million in Medicaid payments since January 1, 2025.

“The Medicaid Fraud War Room is what modern program integrity looks like: federal and state partners working off the same data, in real time, to stop bad actors before more taxpayer dollars go out the door,” said CMS Deputy Administrator and Chief Operating Officer Kim Brandt. “Fifty providers and $203 million in just 88 days is not a coincidence — it’s the result of tighter coordination, better analytics, and a workforce that treats fraud prevention as core mission work, not an afterthought.”

The MFWR was established in coordination with the White House Task Force to Eliminate Fraud and brings together CMS, OIG, state Medicaid agencies, and federal law enforcement partners to identify and rapidly address high-risk providers.

Building on the success of CMS’s Medicare Fraud Defense Operations Center, the MFWR uses advanced analytics to identify suspicious billing patterns, generate investigative leads, and coordinate rapid enforcement actions across federal and state partners.

For more information, visit: www.cms.gov/files/document/medicaid-fraud-war-room-fast-facts.pdf.