Apprise MD

03/10/2026

An American College of Physician Advisors report called for providers to push back and report when insurance plans ignore the rules, stating that “with enough complaints, Centers for Medicare and Medicaid Services will be forced to address this abhorrent behavior.”

There are various ways to report non-compliance by the Medicare Advantage Organizations, in addition to appealing all denials that contradict the CMS regulation.

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An American College of Physician Advisors’ (ACPA) recent report concurs with earlier data from AppriseMD that many Medicare Advantage Organizations (MAOs) are not complying with the guidelines that the Centers for Medicare and Medicaid Services established under rule 4201-F. In its News to Note fr...

03/05/2026

AppriseMD overturned a challenging Medicare Advantage denial after a physician advisor facilitated a peer-to-peer review with the payer medical director. Read more about this short stay at https://apprisemd.com/case-study-challenging-ma-denial-overturned-despite-one-midnight-stay/

03/04/2026

The two-midnight rule was referenced in a recent article published as part of the American Medical Association’s Debunking Regulatory Myths series. This piece discusses reimbursement for a patient leaving against medical advice when doctors had reasonable expectations that the patient would require care over two midnights.

Get real answers from the AMA to common myths about payment for hospital services if a patient leaves against medical advice.

02/26/2026

The elimination of the Inpatient Only (IPO) list aims to give physicians more options on where to perform surgical procedures, while also allowing patients more choices. This move represents a shift from a procedure-based requirement to one of clinical judgment, so not all patients will benefit from the expanded surgical locations.

Read more about the dissmantling of the IPO list at

CMS began dismantling the Inpatient Only list (IPO) on January 1, 2026. This phasing out process will happen over the next three years.

02/24/2026

Healthcare executives are monitoring trends that impact the revenue cycle in 2026. According to HealthLeaders, these trends include the following: rising denial rates, a potential shift from generative AI to agentic AI, policy changes affecting the front-end of revenue cycle, technology investment strategies, and prior authorization.

02/19/2026

An American Medical Association Advocacy Resource Center survey looking at state legislative priorities for medical societies in 2026 showed that 72% of respondents will be "deeply engaged in Medicaid legislation and/or regulation in 2026.” Some of the priorities include physician reimbursement, financial stability and managed care reform. See the full survey at

Learn more about the 2026 AMA State Legislative Survey. The results reveal a unified, urgent and patient-focused heath care agenda for the nation.

02/17/2026

The Centers for Medicare & Medicaid Services (CMS) began dismantling the Inpatient Only (IPO) list on January 1, 2026, by removing 285 musculoskeletal, orthopedic and spine procedures. This phasing out process will happen over the next three years, allowing more procedures to be performed on an outpatient basis, which CMS believes will result in a shorter recovery period.

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CMS began dismantling the Inpatient Only list (IPO) on January 1, 2026. This phasing out process will happen over the next three years.

02/12/2026

Hospitals rely on Apprise MD physician advisors to overturn denials. Check out our latest case study involving a one-month-old infant who was admitted for failure to thrive and a commercial payer who denied reimbursement.

An AppriseMD physician advisor successfully defended a secondary review recommendation for an inpatient LOC admission, resulting in the denial being overturned.

02/10/2026

Aetna’s Level of Severity Inpatient Payment Policy represents a complex shift in MA reimbursement. Though framed as a refinement of payment methodology, the policy’s implications reach far beyond coding or billing. Read more atttps://apprisemd.com/understanding-aetnas-new-level-of-severity-inpatient-payment-policy/

02/04/2026

An infant, who dropped from the 80th percentile in weight at birth to the 10th percentile in weight at just over a month old, was the subject of our latest case study. This two-day hospital stay was initially denied reimbursement by the payer, however an AppriseMD physician advisor was able to overturn this decision following a peer-to-peer review.





https://apprisemd.com/case-study-infant-failure-to-thrive-denial-overturned/

01/29/2026

President Trump’s Executive Order “Ensuring a National Policy Framework for Artificial Intelligence” may undo state laws about how hospitals can use AI. Read more here:

By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered: Section 1. Purpose.

01/22/2026

46% of health plan coverage denials were overturned following an external, independent medical review.
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Nearly half of health plan coverage denials that reached independent medical review were overturned between 2019 and 2023, with significant variation by state, according to a Health Affairs study published Dec. 10. Researchers from the University of California San Francisco analyzed publicly availab...