Louisiana FQHC Reimbursement Watch

CMS proposes slashing 340B drug reimbursement to ASP minus 33.4% under the CY2027 OPPS rule, based on survey data showing lower acquisition costs.

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FQHC billing teams can protect TCM revenue by mastering 99495 timing and documentation.

• Core requirements: Contact within 2 business days, moderate...

FQHC claim denials stem from process gaps, not staffing shortages, with most revenue recoverable through targeted fixes.

• Verify eligibility at...

CMS proposes slashing 340B drug payments to ASP minus 33.4% from the current ASP plus 6%, projecting $4.55B in first-year Medicare savings.

• 340B...

2027 Hospital OPPS Proposed Rule

• 🔥 340B Payment Cuts: CMS released the CY 2027 Hospital OPPS proposed rule that includes significant changes to...

CMS's CY 2027 OPPS proposal slashes 340B drug payments to ASP minus 33.4 percent while hiking the budget neutrality adjustment to 3...

The finalized 2027 NBPP rule updates Marketplace plan design, network adequacy, and Essential Community Provider standards. CHCs should note potential...

CMS proposed new Medicare disenrollment and extended clawback rules in the 2027 Home Health payment rule that apply to all CMS-regulated settings,...

General BHI via CPT 99484 delivers ~$57 per patient monthly for 20+ minutes of clinical staff time with no psychiatrist required.

• Key 2026 options:...

Medicare Audit Trends

• 🔥 AI in Audit Targeting: The integration of artificial intelligence and machine learning into Medicare audit contractor...

Louisiana FQHCs face rising Medicare audit exposure across multiple fronts.

• Common deficiencies in medical necessity, physician notes, and coding...

CMS CY 2027 OPPS Proposed Rule

• Payment Rate Update: CMS proposes a 2.4% update to OPPS payment rates for hospitals meeting quality reporting...

CMS proposes reimbursing 340B drugs at ASP minus 33.4% for 2027, cutting Medicare drug spending by $5.7 billion including $1.15 billion in beneficiary...

Behavioral health billing faces compounded risks from FY2026 ICD-10-CM updates requiring greater specificity in MDD, anxiety, and SUD codes.

• Audit...

Stakeholders warn the CMS-2449 rule would cut state flexibility on supplemental payments, risking provider stability and care access for services...

Elevance Health wired CMS $342 million in alleged Medicare Advantage overpayments after the agency threatened to block new enrollments for...

Billing Code Updates

• 🔥 99490 CPT Code Fee Schedule: The 99490 CPT Code Fee Schedule & Reimbursement Rates for 2026 article details changes to...

Key billing details for Medicare Chronic Care Management under CPT 99490:

• Reimbursement: National average non-facility rate hits ~$66 per patient...

Louisiana FQHCs face mounting pressures from federal enforcement, state reporting threats, and policy shifts.

• DOJ fraud takedown uses data...

CMS issued an RFI on June 16, 2026, seeking input on PBM compensation restrictions and data reporting under Section 6224 of the CAA 2026. The rules...