Payer Pulse

Actionable payer policy intelligence for hospitals and provider organizations in the KC Metro.

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Latest Issue: Spring 2026

Key Takeaways:

  • • Aetna eliminating reimbursement for treatment room services starting June 2026
  • • UHC tightening referral enforcement for Medicare Advantage members
  • • Blue KC shifting recovery room billing to per-minute units
  • • RPM coverage restricted to select chronic conditions

Top Priority Action Items

  • ✅ Ensure ICD-10 codes are correctly formatted for MO HealthNet pharmacy claims
  • ✅ Update workflows to capture required PCP referrals for UHC Medicare Advantage
  • ✅ Replace outdated ABN forms before May 12, 2026
  • ✅ Review Aetna bundling rules for treatment room services
  • ✅ Evaluate financial impact of OB coding changes (2027)

Hot Topics This Quarter

  • OB Coding Overhaul (2027): Preparing for the elimination of global maternity billing
  • Escalation Opportunity: Aetna ventral hernia policy conflicts with CPT guidance
  • Trend Watch: Increasing restrictions on Remote Patient Monitoring coverage

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Past Issues

  • Winter 2026 – #Download PDF
  • Fall 2025 – #Download PDF
  • Summer 2025 – #

Payer Pulse is developed in partnership with healthcare reimbursement experts to help providers navigate evolving payer policies and reimbursement risks.