In response to advocacy by the American Academy of Sleep Medicine and other medical organizations, Cigna has agreed to pause its automatic downcoding policy — Evaluation and Management (E/M) Coding and Accuracy Policy (R49) — effective Oct. 1, 2025. In the AASM’s letter [...]
As of Oct. 1, the federal government shut down after Congress failed to pass a funding bill. Sleep medicine professionals may be wondering how this will affect Medicare operations. Here is what you need to know as you continue to provide high-quality care [...]
Two large private payers, Aetna and Cigna, plan to implement downcoding policies beginning Oct. 1, 2025. The Aetna and Cigna policies will rely on automatic downcoding of evaluation and management (E/M) services without reviewing clinical documentation. Downcoded claims may lead to appeals, delaying [...]
On Sept. 16, 2025, House Republicans introduced a stopgap continuing resolution (CR) to fund the federal government through Nov. 21, 2025. While primarily designed to prevent a government shutdown, the CR included a provision to extend Medicare telehealth flexibilities through Nov. 21, 2025. [...]
On July 14, the Centers for Medicare & Medicaid Services filed the 2026 Medicare Physician Fee Schedule and Quality Payment Program proposed rule, which includes potential revisions to payment policies under the physician fee schedule, quality payment program and other Medicare Part B [...]
On Aug. 11, 2025, the American Academy of Sleep Medicine joined more than 340 organizations in sending a letter to congressional leaders to request that Medicare beneficiaries maintain continued access to telehealth services, beyond when flexibilities are set to expire on Sept. 30, [...]
AASM staff attended the 2025 CMS Quality Conference (#QualCon25), held on July 1–2. This year’s theme was “Make America Healthy: Improving Health Outcomes Through Prevention, Quality, and Safety.” CMS prioritized key areas including: Chronic disease prevention Advancing artificial intelligence Prioritizing prevention Successful interoperability Transitioning [...]
On July 1, 2025, the Centers for Medicare & Medicaid Services (CMS) released the 2023 Quality Payment Program (QPP) Experience Report. This document provides data specific to sleep medicine providers as it relates to Merit-based Incentive Payment System (MIPS) measures. Per the 2023 [...]
On Monday, July 14, the Centers for Medicare & Medicaid Services (CMS) released the 2026 Medicare physician fee schedule proposed rule, which includes potential revisions to payment policies under the physician fee schedule, the Quality Payment Program, and other Medicare Part B payment [...]
On June 29, 2025, CMS announced the Wasteful and Inappropriate Service Reduction (WISeR) Model, a new payment model under the Center for Medicare and Medicaid Innovation targeting waste, fraud and abuse in Medicare fee-for-service. Unlike Medicare Advantage, Medicare fee-for-service has not previously implemented [...]