A Strong Finish Starts Now: October Insights from MRCS

Sep 30

7 min read

October has arrived, marking the start of the fourth and final quarter of the year—a good time to review priorities and finish the year strong.

October is also recognized as Breast Cancer Awareness Month—a time to honor those affected and reinforce the importance of education, screening, and early detection. Together with Health Literacy Month, this observance reminds us that clear, accessible information matters at every level of healthcare—from helping patients understand their care to helping healthcare professionals navigate changing billing, compliance, and operational requirements.

In this month’s newsletter, we’re sharing timely deadlines, Medicare and coding updates, practical resources, educational opportunities, and MRCS highlights to help you and your organization move through the final quarter with greater clarity and purpose.

We begin with a closer look at several October observances that celebrate awareness, education, and healthcare professionals who support patients every day.

🔔 Immediate Action Items for October

October brings several important implementation dates, payment updates, and year-end deadlines. To help you focus, we’ve highlighted the items most likely to affect your organization’s billing, compliance, reporting, and payer workflows.

Medicare System Alert: October 2–4

The Common Working File will have scheduled “dark days” during the October release installation. IVR availability and certain Medicare processing functions may be limited, although Novitasphere will remain available for eligibility inquiries. Billing and eligibility teams should anticipate possible delays.

📍 Maryland Medicaid Provider Alert

Prepare for the MPRIME Transition

Maryland Medicaid is preparing to launch MPRIME later this month and end the current provider-application holds. Enrollment and credentialing teams should review the transition guidance, confirm account access, and prepare to use MPRIME for enrollment, revalidation, and provider updates.

Begin Preparing for 2027 Maternity Care Coding Changes

Beginning January 1, 2027, maternity care services will transition from traditional global reporting to more detailed service-level coding. OB/GYN practices should begin reviewing documentation, billing workflows, payer policies, fee schedules, EHR configurations, and staff training needs.

Confirm October Coding and Payment Updates

Confirm implementation of the October updates to ICD-10, HCPCS, the Medicare Physician Fee Schedule Database, Medicare NCCI edits, and Medicaid NCCI edits. Make sure systems, fee schedules, claim edits, and staff guidance reflect the changes applicable to your organization.

Verify Medicare Drug and Vaccine Pricing

Organizations that administer separately payable Part B drugs or seasonal vaccines should review the newly effective October 2026 Part B drug pricing files and current Medicare vaccine pricing. Update billing systems and NDC-to-HCPCS mappings as needed.

Complete October QPP Follow-Up

Sign in to the Quality Payment Program to review 2025 MIPS performance feedback and final scores. If you believe CMS made an error, submit a Targeted Review within the available review period.

Organizations expecting a 2026 APM Incentive Payment should also review the QP Payments information. If an expected payment was not received, check the 2026 QP Notice in the QPP Resource Library and provide updated Medicare billing information by October 13 if listed.

Check the Final Ambulatory Specialty Model Participant List

CMS has released the final participant list for the mandatory Ambulatory Specialty Model beginning January 1, 2027. Practices with cardiologists or designated specialists treating low back pain should confirm whether any physicians are listed by TIN/NPI. Selected participants should review CMS’s preparation resources and begin planning for required reporting and future Medicare Part B payment adjustments.

Review Preliminary 2027 Medicare Laboratory Rates

Laboratories should evaluate the preliminary CY 2027 Clinical Laboratory Fee Schedule rates and their potential reimbursement impact. Comments are due October 21.

Update Availity Authentication by October 28

Availity Essentials users who currently authenticate by text message or voice call must switch to an authenticator app by October 28 to avoid interrupted access. Primary administrators should identify affected users and confirm that authentication has been updated. Essentials Pro and single sign-on users are excluded.

Prepare for Federal IDR Workflow Changes

Updated federal Independent Dispute Resolution batching requirements apply to disputes with open-negotiation periods beginning on or after November 1. Organizations involved in out-of-network payment disputes should review the implementation timeline and update applicable workflows.

🧾 Payer Alerts

Review UnitedHealthcare October Updates

Confirm applicable October billing and prior authorization changes, including the removal of certain prior authorization requirements for most plans.

Review CareFirst Medication Changes

Identify commercial members affected by the October 1 prior authorization, site-of-care, and preferred-drug changes.

Review Wellpoint Billing and Transaction Changes

Review applicable October billing and medication-authorization changes. Confirm electronic claims and payment arrangements before certain paper-based transaction fees may begin November 1.

Addressing these items now can help you meet upcoming deadlines, support accurate reimbursement, and reduce avoidable claim and payment disruptions across your organization.

🔍 Key CMS & Industry Updates

Beyond the immediate deadlines outlined above, several broader developments may influence reimbursement, compliance, and planning for 2027.

Prepare for the 2027 CPT Code Set

The AMA released 453 CPT changes, including 299 new codes, 74 revisions, and 80 deletions effective January 1, 2027. Organizations should begin identifying changes that may affect documentation, coding, fee schedules, payer policies, system configuration, and staff education.

Follow the New Medicaid Quality Direction

CMS and 37 states are working to place greater emphasis on measurable health outcomes, digital quality measurement, and reduced reporting burden in Medicaid and CHIP. Organizations serving Medicaid populations should monitor how these priorities shape state quality strategies, value-based arrangements, and future procurements.

Monitor the 2027 Medicare Laboratory Payment Outlook

CMS’s preliminary rates show lower weighted median payments for many clinical laboratory tests, with final CY 2027 rates expected in November. Laboratories and organizations providing laboratory services should assess potential reimbursement exposure and prepare for phased payment reductions where applicable.

Strengthen Medicare Program Integrity

CMS reports preventing more than $1.6 billion in potentially improper laboratory payments through advanced analytics, payment suspensions, enrollment actions, and overpayment recovery. The increased oversight reinforces the importance of medical necessity, accurate coding, ordering-provider relationships, documentation, and internal billing controls.

Keeping these developments visible can help your organization plan thoughtfully, strengthen compliance, and prepare for the changes ahead.

💡 MRCS Revenue Cycle Quick Tip

Denial management should do more than recover individual claims- it should reveal where a process needs to improve. This month’s quick tip focuses on moving beyond rework and correcting denials at their source.

🎤 MRCS in Action: Sharing Expertise Across Healthcare

The MRCS team closed September by sharing practical revenue cycle guidance with healthcare leaders in Texas and Maryland—and begins October with another important educational engagement in Louisiana.

Celebrating 100 Years of MGMA

Earlier this week, Kem Tolliver, FACMPE, CPC, CMOM, represented MRCS at the MGMA Annual Conference in San Antonio, TX. This milestone event celebrated MGMA’s 100-year history of bringing the practice management community together to learn, connect, and lead.

Kem co-presented Strategic Revenue Cycle Workplan Design for High-Impact Payer Engagement with Doral Jacobsen, MBA, FACMPE, and Taya Gordon, MBA, FACMPE, moderated a peer discussion on denial management for hospital- and system-owned practices, and helped facilitate the Black Healthcare Leaders Resource Group networking session. The BHL gathering created space for meaningful connections, shared experiences, and continued leadership development among Black healthcare professionals.

MRCS extends a special thank-you to MGMA, the conference organizers, fellow presenters, facilitators, and attendees who made this centennial gathering such a meaningful experience.

We were honored to contribute to the conversations shaping the future of medical practice management.

Community Education in Action

MRCS appreciates the opportunity to support professional learning close to home. A special thank-you to Barbara Taylor and the Prince George’s County Practice Managers Association for coordinating this complimentary program and welcoming Charletta Washington, MHA to share with local practice leaders.

Next Stop: NORM in New Orleans

As this issue reaches your inbox, Kem is beginning the 2026 National Organization of Rheumatology Management Conference in New Orleans.

On October 2, she will lead a general session on developing an RCM work plan tailored to rheumatology practices. On October 3, she will present A Foundational, Step-by-Step Approach for Revenue Cycle Management for New Managers, helping newer leaders understand the complete revenue cycle, recognize specialty-specific risks, establish workflow ownership, and begin improving one process at a time.

We’re proud to see MRCS professionals sharing practical knowledge, supporting healthcare leaders, and contributing to stronger organizations across the industry.

✨ Strengthening Our Partnership with PMI

This week, members of the MRCS and Practice Management Institute® (PMI) teams gathered for dinner—an opportunity to strengthen a longtime partnership, enjoy meaningful conversation, and connect beyond the work we do together.

The dinner also marked a special milestone: although Kem and members of the PMI team have worked together for nearly 15 years, this was the first time several of them had the opportunity to meet in person.

We’re grateful for the people and relationships behind this partnership and for our shared commitment to supporting healthcare professionals through practical education and continued professional development.

Pictured from left: David Womack, President, PMI; Liz Molina, Business Operations Manager, MRCS; Kathleen Riexinger, Director of Student Experience, PMI; Michael Moore, Vice President—Partner Development, Institutional Development, and Workforce Initiatives, PMI; and Kem Tolliver, President and CEO, MRCS.

📚 Invest in What’s Next

Our partnership with PMI continues through the MRCS Learning Center, where healthcare professionals can explore practical education and credentialing opportunities designed to support continued growth.

Learn More

⭐ Up Next: MRCS at Ufinity 2026

Register

Unlimited Systems Ufinity Conference 2026 November 1–3 | Nashville, TN

The momentum continues in November as Kem Tolliver, FACMPE, CPC, CMOM, heads to Nashville to deliver a keynote presentation at Ufinity 2026.

Kem’s presentation will explore revenue cycle leadership, operational excellence, technology adoption, and innovation—offering practical perspective for organizations preparing to meet the industry’s next challenges.

We look forward to connecting with healthcare leaders in Nashville and continuing the conversations that move our industry forward.

🤝 We’re Here to Help

As your organization moves through the final quarter, MRCS is here to help you address challenges, strengthen performance, and prepare for what comes next. We support the people, processes, and technology behind healthcare operations through revenue cycle and practice management, payer contracting, coding and risk management, healthcare technology optimization, and content and coaching.

Explore MRCS Services, follow MRCS on LinkedIn for industry insights and updates, or email admin@medrevenuecycle.com to continue the conversation.

🩷 Closing Thoughts

October reminds us that meaningful progress begins with awareness—but grows through clear information, thoughtful planning, and consistent action. We hope this issue gives you useful guidance as you support your team, strengthen your organization, and prepare for the changes ahead.

During Breast Cancer Awareness Month, we also recognize the patients, survivors, families, caregivers, and healthcare professionals whose strength, compassion, and dedication make a difference every day.

As fall settles in and the final quarter gets underway, we hope you find time to enjoy the season, reconnect with what matters, and celebrate the progress you and your organization continue to make.

Thank you for continuing to learn, lead, and stay connected with MRCS.

With appreciation, The MRCS Team