Following the implementation of downcoding policies by two major private payers, Aetna and Cigna, effective Oct. 1, 2025, AASM analyzed payer trends and identified additional health plans with active or proposed downcoding programs targeting higher-level evaluation and management (E/M) services. These include Ambetter [...]
The American Academy of Sleep Medicine joined more than 450 national health care organizations in signing on to a letter urging Congress to pass a long-term solution for Medicare telehealth coverage. The letter, sent to congressional leaders on Nov. 4, 2025, highlights how repeated [...]
The Centers for Medicare & Medicaid Services has issued the calendar year 2026 Medicare physician fee schedule final rule, outlining policy and payment changes that will take effect Jan. 1, 2026. The physician fee schedule governs payment for physician and other health professional [...]
On Oct. 15, the Centers for Medicare & Medicaid Services announced that clinicians who participated in the Merit-based Incentive Payment System (MIPS) in 2024 may now view their performance feedback, which includes the final score and payment adjustment factors. The final score determines [...]
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, [...]