Staying Ahead: August Insights from MRCS

4 days ago
7 min read

We hope you’re enjoying the summer and finding time to recognize the progress your organization and team have made this year.

As we move through August, healthcare organizations are preparing for several important developments, proposed and final 2027 Medicare payment updates, updated vaccine pricing, a major restructuring of maternity care coding, and evolving telehealth, Medicaid, and compliance requirements.

Staying ahead means understanding which changes require attention now, what may affect future reimbursement, and where operational processes may need to be reviewed or strengthened. With thoughtful planning, organizations can respond to change while continuing to support their teams and the patients they serve.

In this month’s newsletter, we’re sharing timely government and industry updates, practical considerations for healthcare organizations, and recent MRCS highlights that reflect our continued commitment to education, leadership, and stronger healthcare operations.

🔔 Immediate Action Items for August

As healthcare organizations prepare for the months ahead, several upcoming changes and deadlines deserve attention.

Review CY 2027 Medicare Payment Proposals CMS has proposed changes affecting physician practices, hospital outpatient departments, ambulatory surgical centers, and home health agencies. Organizations should assess reimbursement, quality-reporting, prior authorization, and operational impacts. Comments on the OPPS/ASC and Home Health proposed rules are due August 31, while Physician Fee Schedule comments are due September 14.

Strengthen Clinical Laboratory Readiness CMS is seeking comments to help update CLIA regulations through September 14. Laboratories should also prepare for ICD-10-CM changes affecting Laboratory National Coverage Determination edits beginning October 1, including any necessary system updates, testing, or staff education.
Verify 2026–2027 Vaccine Pricing CMS has released Medicare pricing and effective dates for seasonal influenza and COVID-19 vaccines. Organizations administering these vaccines should confirm current payment allowances, update billing systems as needed, and monitor the CMS webpage for additional pricing updates.

Begin Preparing for 2027 Maternity Care Coding Changes Effective January 1, 2027, traditional global maternity care codes will be replaced with separate reporting for antepartum care, labor management, delivery, and postpartum services. As one of the most significant maternity coding changes in decades, this transition will require OB/GYN practices to review documentation, billing workflows, payer contracts, fee schedules, EHR configurations, and staff training.

Prepare for the PEPPER Relaunch CMS is preparing to relaunch the Program for Evaluating Payment Patterns Electronic Report for all Medicare facility types. Authorized officials, access managers, and staff end users should confirm their CMS Identity & Access credentials and request the PEPPER business function now to support access when reports are released.

Protect Pending PECOS Applications PECOS automatically deletes inactive Medicare enrollment applications. Enrollment and credentialing teams should monitor pending submissions, address outstanding requests, and respond promptly to keep applications moving forward.

📍 Maryland Medicaid Provider Alert

Prepare for the MPRIME Enrollment Portal Transition Maryland Medicaid is transitioning from ePREP to the new MPRIME provider enrollment portal in October. As of August 1, applications for all provider risk categories are temporarily on hold, and new or updated applications submitted during this period will be returned without processing. Maryland providers should monitor outstanding revalidations, watch for August and September training opportunities, and prepare for the October launch.

🧾 Payer & Medicare Contractor Alerts

Prepare for Novitas OPD Post-Payment Reviews Novitas began issuing additional documentation requests on August 1 to exempt hospital outpatient departments for 10-claim post-payment samples of finalized claims with dates of service from January 1 through June 30, 2026. Affected organizations should monitor ADRs and be prepared to submit supporting documentation promptly.

Review UnitedHealthcare Commercial Billing and Gold Card Updates Beginning October 1, UnitedHealthcare will require in-network outpatient facilities to report appropriate CPT/HCPCS codes with certain revenue codes on UB-04 claims; claims missing required codes will not be eligible for reimbursement. Provider groups should also check their Gold Card eligibility status beginning September 1, with qualified groups becoming eligible October 1.

Review New CareFirst Medication and Site-of-Care Requirements Effective October 1, additional medications will require prior authorization and site-of-care management for CareFirst members with commercial insurance. Practices should review the affected medication list, identify patients whose treatment may be impacted, and update authorization and scheduling workflows before the change takes effect.

Prepare for Wellpoint Electronic Claims and Payments Effective November 1, Wellpoint commercial providers that continue using certain paper-based claims and payment processes may incur administrative fees. Practices should confirm that electronic claim submission and payment arrangements are active and update affected workflows to avoid unnecessary costs.

Addressing these areas now can help organizations meet upcoming deadlines, prepare for reimbursement changes, and reduce future billing disruptions.

🔍 Key CMS & Industry Updates

Beyond the immediate action items outlined above, several broader developments continue shaping reimbursement and operational oversight:

Final FY 2027 Medicare Facility Payment Rules CMS has finalized FY 2027 payment and quality-reporting updates affecting acute-care hospitals, long-term care hospitals, inpatient rehabilitation facilities, hospice providers, skilled nursing facilities, and inpatient psychiatric facilities. Organizations should review the rules applicable to their facility type and assess potential payment, wage-index, quality-reporting, and operational impacts ahead of FY 2027.

2027 Medicaid Work and Community-Engagement Requirements Beginning January 1, certain adult Medicaid applicants and beneficiaries will need to document at least 80 hours per month of qualifying activities, subject to applicable exemptions. Organizations serving Medicaid populations should monitor Maryland’s implementation and prepare for potential effects on eligibility verification, coverage continuity, and patient communication.

Medicare Telehealth Flexibilities Many Medicare telehealth flexibilities remain extended through December 31, 2027. Organizations should continue monitoring coverage, coding, and documentation requirements.

Medicaid Payment-Rate Transparency For rating periods beginning on or after July 9, 2026, Medicaid managed-care payment analyses must include certain provider payment information and comparisons with published Medicare rates. This added visibility may help organizations monitor reimbursement trends and better understand Medicaid payment levels.

CMS Medicaid Program Integrity Enforcement
CMS reports that its Medicaid Fraud War Room stopped more than $203 million in potentially improper payments during its first 88 days. This recent enforcement activity reinforces the importance of strong documentation, billing oversight, and compliance monitoring.

Staying informed about these developments can help organizations anticipate change and make thoughtful operational decisions.

🌟 Summer Intern Spotlight: Kamarre Lawrence

As Kamarre Lawrence’s summer internship comes to a close this August, MRCS is pleased to recognize his contributions and celebrate all he has accomplished.

Kamarre attends Hood College, where he is studying Business Administration with a concentration in Finance and nearing completion of a minor in Economics. During his time at MRCS, he’s supported internal projects through data organization, project tracking, presentation development, and coordination while gaining valuable insight into healthcare billing, insurance, and provider reimbursement.

💬 In Kamarre’s Words - “What I have enjoyed most is creating spreadsheets for Ms. Kem and feeling like I am helping the team.”

We sincerely thank Kamarre for his hard work and positive attitude. We wish him continued success as he returns to Hood College and works toward his goal of becoming a financial advisor.

📚 Continue Learning with MRCS

As we wish Kamarre success in his next chapter, his summer with MRCS reminds us that every professional journey is strengthened by opportunities to learn, contribute, and grow.

Whether you are building foundational knowledge, strengthening your leadership skills, or preparing for your next professional opportunity, the MRCS Learning Center offers practical education and resources designed to support your continued growth.

Learn More

🎙️ Now Available: Kem Tolliver on the Cancer Clearly Podcast

Earlier this summer, we shared that MRCS President and CEO Kem Tolliver, BS, FACMPE, CPC, CMOM, would be joining Amplity’s Cancer Clearly podcast. We’re pleased to announce that the full episode is now available!

In this conversation, Kem explores why oncology revenue cycle management is about more than reimbursement—it also plays an important role in helping patients access the care they need, when they need it.

Listeners will gain practical insights into:

Preventing denials before they happen
Building workflows that support patients and providers
Using technology to strengthen effective processes
Preparing oncology practices for value-based care

🎧 Watch or listen to the full episode

📅 Where You’ll Find MRCS Next

MRCS is proud to participate in educational programs and industry events that bring healthcare professionals together to learn, connect, and exchange practical ideas. We hope to connect with you at one of these upcoming engagements.

Free 2026 PHIT Week Workshop

August 17, 2026 at 5:00 PM – August 21, 2026 at 7:00 PMWebinar

Future-Proofing Your Practice: Revenue Cycle Strategies Every Medical Practice N...

August 6, 2026, 1:00 – 3:00 PMVirtual Conference

Practice Excellence Webinar Series: Risk Management for Medical Practices

August 13, 2026, 12:00 – 1:00 PMWebinar

Black Healthcare Leaders Resource Group

September 28, 2026, 8:30 – 9:30 AMHenry B. González Convention Center

WS1: Strategic Revenue Cycle Workplan Design for High-Impact Payer Engagement

September 27, 2026, 12:15 – 2:30 PMHenry B. González Convention Center

2026 NORM Conference

October 1, 2026 at 8:00 AM – October 3, 2026 at 8:00 AMHyatt Regency New Orleans

Ufinity Conference 2026 | Keynote Presenter

November 1, 2026 at 7:00 PM – November 3, 2026 at 11:00 PMGrand Hyatt Nashville

💙 A Meaningful MRCS Milestone

On July 29, our team came together in Annapolis, Maryland, for the first-ever MRCS company retreat. With team members traveling from across the country, it was truly special to have so many members of the MRCS family together in one place.

The day gave us an opportunity to reflect on how far we have come, share ideas, and look ahead to how we can continue growing while serving healthcare organizations with excellence. The thoughtful conversations, fresh perspectives, and shared commitment around the table reminded us that the strength of MRCS begins with our people.

We ended the day with a waterfront dinner, Maryland crabs, plenty of laughter, and time to enjoy one another’s company. We left Annapolis feeling grateful, inspired, and even more excited about the future of MRCS.

Thank you to every team member who helped make our first retreat such a meaningful and memorable milestone. We look forward to carrying that energy forward as we continue supporting our clients and the healthcare community.

🎉 Celebrating Four Years with MRCS

This August, MRCS is proud to celebrate Nick Fernandez, MBA, Director of Marketing & Communications, as he marks four years with our team.

Throughout his time with MRCS, Nick’s creativity, strategic perspective, and dedication have helped strengthen our brand, expand our reach, and share the work and expertise of our team with the healthcare community.

Thank you, Nick, for four years of valuable contributions and continued commitment to MRCS. We appreciate all that you do and look forward to celebrating many more milestones together!

💭 Closing Thoughts

This month’s updates remind us that progress in healthcare depends not only on understanding policy and strengthening operations, but also on the people who remain curious, share their expertise, and lead through change.

We hope this issue offers useful perspective as you plan for the months ahead. Whether you are navigating regulatory changes, strengthening your organization, or taking the next step in your professional journey, MRCS is honored to be a trusted resource along the way.

Thank you for continuing to learn, grow, and stay connected with us. We look forward to sharing more with you in September.

With appreciation,

The MRCS Team