Bobbi Buell's Newsletter

Roberta L. Buell is a Principal at onPoint Oncology Inc., specializing in oncology reimbursement. With over 23 years of experience in billing, coding, and drug therapy reimbursement, she's a nationally recognized expert and frequent speaker on regulatory and reimbursement issues. Bobbi has led more than 600 seminars since 1991 and currently serves as content director for focalPoint® and assistPoint®. Learn more about Bobbi here .

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February 2026

OPPS Q1: Better Late Than Never

The Transmittal for First Quarter, 2026 , was delayed almost a month. What? At this point, we can say this transmittal is action-packed and important. I would guess that is why the MACs had to scramble in the first month of 2026. Anyway, check it out — some really useful content. ASP Changes from the Final Rule Effective January 1, 2026, payment rates for many drugs and biologicals have changed from the values published in the CY 2026 OPPS/ASC final rule due to new ASP calculations based on sales price submissions from the third quarter of CY 2025. In cases where adjustments to payment rates are necessary, they will be incorporated into the January 2026 Fiscal Intermediary Standard System (FISS) release. CMS is not publishing the updated payment rates in this Change Request; it is implementing the January 2026 OPPS update. However, the updated payment rates, effective January 1, 2026, can be found in the January 2026 update to the OPPS Addenda A and B on the CMS website.…

February 2026

Medicare Advantage & Part D Proposed Rule 2027

The Centers for Medicare and Medicaid Services (CMS) released the Contract Year 2027 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program. CMS projects that the proposed updates would result in an average net payment increase of 0.09% in 2027, or 2.54% after accounting for expected coding trends. These figures are preliminary and will likely change before the final rate notice is issued on or before April 6, 2026. Just as importantly, the impact will vary widely by plan based on geography, enrollee risk profile, and quality bonus eligibility, underscoring why stakeholders should look beyond the headline number. Comments on this proposed rule were due to CMS by January 26, 2026. But comments may be largely ignored anyway. Medicare Part D Redesign The Inflation Reduction Act of 2022 (IRA) introduced major changes to the Medicare Part D prescription drug benefit and gave CMS temporary authority—through…

February 2026

Telehealth Extended to 12/31/2027 and More!

President Trump on Tuesday signed into law a funding bill that ended a short-term partial government shutdown, funds the Department of Health and Human Services, extends telehealth and virtual care flexibilities, and enacts pharmacy benefit manager reform. What's not to like? See the next paragraph. The minibus package did not revive Affordable Care Act enhanced premium tax credits that expired December 31, 2025. Nor did it include provisions from President Trump's healthcare plan to send money directly to consumers' health savings accounts. The Senate on January 29 voted 71-29 to advance the package, and the House on February 3 voted 217-214 to send the bill to President Trump for his signature. The bill includes the following: Telehealth--There will be a two-year extension of Medicare telehealth flexibilities. This means all provisions in effect before January 31, 2026, are reinstated. The provisions are slated to end December 31, 2027. The bill also requires HHS to issue guidance…