Traditional MedicareAdministrativeMedium impact
2026-07-23 - CMS Modernizes Nursing Home Oversight with New Risk-Based Survey Approach Designed to Highlight High Performance, Encourage Improvement
Medicare/CMS·Quality Measures
We identified it
Jul 23, 2026
Summary
This MLN Connects newsletter (July 23, 2026) contains multiple policy updates affecting different provider types: nursing home survey processes now use risk-based approaches; clinical labs must report private payor data by July 31, 2026; ACOs must submit participant lists by August 5, 2026; PEPPER billing analysis tool is relaunching; and enteral nutrition claims show high improper payment rates (23.8%) requiring billing corrections.
Action Required
REQUIREMENTS:
1. By July 31, 2026: Clinical laboratory staff must report CLFS data to CMS including applicable HCPCS codes, private payor rates, and volume data (January 1 – June 30, 2025 period). Use the CLFS Data Collection System. Failure to report may result in civil monetary penalties.
2. By August 5, 2026: If your practice participates in an ACO, work with the ACO to ensure your taxpayer identification numbers are on their participant list submitted to CMS (Noon ET for Medicare Shared Savings Program; 11:59 pm ET for LEAD Model). Resolve any overlapping TIN registrations by September 8, 2026.
3. By September 14, 2026: If your practice operates clinical laboratories, submit any comments on proposed CLIA regulations updates (breath testing, laboratory procedures, emergency preparedness, cybersecurity, specialty testing).
4. Immediately: Billing team should download PEPPER reports from the PEPPER Portal to review your organization's Medicare billing patterns. Request PEPPER business function access through CMS Identity & Access System if not already granted. Use reports to identify over-coding, under-coding, billing pattern issues, and trends before problems arise.
5. Immediately: Review enteral nutrition billing practices. Update billing codes and documentation requirements to prevent denials. Staff should reference the Enteral Nutrition compliance tip to understand common denial reasons and refill/documentation requirements (23.8% improper payment rate in 2024).