Apprise MD

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.

Read more at

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

02/12/2026

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.
Read more here:

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...

01/19/2026

"Life’s most persistent and urgent question is, ‘What are you doing for others?’”
― Martin Luther King Jr.

MLK Jr. Day 2026"

01/15/2026

As of this month, MAOs should not be able to deny short-stay inpatient admissions ordered by a physician if the medical record supports an inpatient admission of two or more midnights and only the information available upon admission can be used to determine medical necessity. The CY 2026 rule negates a payer’s ability to deny coverage using information that arises during the hospital stay, holding the MA plans accountable for what they approve on day zero.
Read more at

Our MA & the Two-Midnight Rule Data Review paper examines a year of AppriseMD P2P data and reviews the Medicare population landscape and key UR review changes.

01/13/2026

A law restricting health insurance companies from using AI to alter provider codes that otherwise change the provider’s clinical judgment was introduced in New Hampshire. You can read more about this in the Becker's Healthcare article, "New Hampshire lawmakers introduce bills targeting AI-driven claims audits, telehealth parity," and then go to our website and download our paper The Use of AI in Claim Denials.

https://www.beckerspayer.com/policy-updates/new-hampshire-lawmakers-introduce-bills-targeting-ai-driven-claims-audits-telehealth-parity/

01/10/2026

Aetna’s Level of Severity Inpatient Payment Policy appears to be rooted in aligning payment levels more closely with clinical severity while also increasing consistency across facilities. Read more about this at https://apprisemd.com/understanding-aetnas-new-level-of-severity-inpatient-payment-policy/

01/08/2026

AppriseMD’s MA P2P data illuminate the importance of taking a consistent and aggressive approach to overturn denials. With 86% of the MA P2P denials demonstrating non-compliance with the Two-Midnight rule, hospitals need to ensure that every opportunity to overturn a denial is taken.

Read our paper, "A Closer Look," at https://apprisemd.com/medicare-advantage-two-midnight-rule-data-followup/