Do we keep up with insurance payer changes in reimbursement schedule?

Do we keep up with insurance payer changes in reimbursement schedule?

How do I keep up with insurance payer changes and reimbursement schedules?

Yes... and staying current with insurance payer changes is critical to ensuring accurate reimbursements and preventing claim denials.

Health insurance payers, including Medicare, Medicaid, and commercial plans, regularly update their reimbursement schedules, coverage policies, billing requirements, and prior authorization rules. These changes can affect how much a provider gets paid, what documentation is needed, and whether a service is considered billable.

Both medical billers and healthcare providers must stay informed to remain compliant and optimize revenue.

Why Reimbursement Schedules Change

Insurance payers update their reimbursement policies for reasons such as:

  • Annual CMS fee schedule adjustments

  • CPT or HCPCS code updates

  • Policy revisions for medical necessity

  • Changes in provider network status

  • Shifts in prior authorization or documentation requirements

Example: Medicare’s Physician Fee Schedule (PFS) is updated annually. In 2024, several E/M codes were revalued, which impacted payment amounts. Practices unaware of these changes risked billing outdated rates.

How to Stay Informed

1. Subscribe to Payer Newsletters

Most major payers (e.g., Aetna, UnitedHealthcare, Blue Cross Blue Shield) offer provider newsletters or email updates. These announce changes in reimbursement rates, billing requirements, and prior authorization guidelines.

Tip: Designate a team member to monitor and share updates from payer bulletins each month.

2. Check Payer Portals Regularly

Each payer maintains a provider portal where you can:

  • Access updated fee schedules

  • View policy manuals and coding updates

  • Monitor claim status and authorization requirements

Example: A biller working with Cigna logs into the Cigna for Health Care Professionals portal weekly to review policy updates and announcements.

3. Monitor CMS and MAC Websites

For Medicare, the Centers for Medicare & Medicaid Services (CMS) posts national updates, and each state or region’s Medicare Administrative Contractor (MAC) provides localized billing and reimbursement changes.

Example: Noridian or Palmetto GBA MACs publish quarterly updates and local coverage determinations (LCDs).

4. Use Coding Tools and Associations

Stay current using:

  • Tools like Find-A-Code, AAPC Coder, or Codify

  • Membership with professional organizations like AAPC or HBMA

These sources summarize payer changes and coding guidance that can affect billing and reimbursement.

5. Engage with Industry Webinars and Forums

Webinars hosted by CMS, payers, and billing associations are excellent for deep dives into annual changes, like the CPT/HCPCS code revisions or telehealth policy updates.

6. Track and Document Internally

Keep a centralized log or CRM record of payer changes as they are announced. This helps train staff and avoid repeating costly mistakes.

Idea

Pro Tip: Use your project management software to document payer change alerts and assign follow-up tasks to your billing team.

Summary

Keeping up with insurance payer changes is essential—and it’s a team effort. Establish internal processes for monitoring and implementing updates, and make it a routine part of your revenue cycle workflow. By staying informed, your practice can:

  • Reduce claim denials

  • Ensure timely payments

  • Stay compliant with payer rules

  • Protect revenue and cash flow


    • Related Articles

    • What are the steps in medical billing process?

      10 Steps in the Medical Billing Process The medical billing process is a series of steps completed by billing specialists to ensure that medical professionals are reimbursed for their services. Depending upon the circumstances, it can take a matter ...

    • Tips for setting up secondary insurance in your practice management software

      Tips for Setting Up Secondary Insurance in Your Practice Management Software Setting up secondary insurance correctly in your practice management software is essential for accurate claim submission, proper payment tracking, and patient satisfaction. ...

    • Common Pitfalls in Pediatric Billing—and How to Avoid Them

      Common Pitfalls in Pediatric Billing—and How to Avoid Them Pediatric billing might seem straightforward, but it comes with its own set of unique challenges. From frequent well-child visits to age-specific vaccine schedules and coordination with ...

    • Do You Need Certification for Medical Billing and Coding?

      Certification is not strictly required for most outpatient medical billing roles—but pursuing one can strengthen your knowledge, credibility, and long-term career potential. This is especially true if you plan to specialize in coding-intensive roles, ...

    • How does secondary billing work with medicare as primary?

      How Does Secondary Billing Work with Medicare as Primary? When Medicare is the primary insurance, billing a secondary payer—such as a commercial plan, Medicaid, or a supplemental policy—follows a structured process. Understanding how secondary ...