A bi-weekly newsletter from your physician organization to keep you informed of today's healthcare news

The Centers for Medicare & Medicaid Services (CMS) is proposing a significant reduction in reimbursement when Modifier-25 is reported with an E/M or surgical service.

Under the proposed policy, when Modifier-25 is appropriately used, CMS would pay the highest-valued service at 100% of the applicable fee schedule, while the secondary service reported with Modifier-25 would be reimbursed at 50% of the fee schedule.

This proposed change is particularly concerning because of its potential impact on physician reimbursement, practice sustainability, and access to care.

Blue Cross proposed this type of fee schedule change earlier this year - thanks to strong advocacy efforts of physicians, physician organizations and other healthcare advocates, the policy was reversed before it went into effect. We now have an opportunity to make our voices heard again, this time directly to CMS.

HOW TO USE YOUR VOICE FOR POSITIVE CHANGE:

CMS is accepting formal comments on this proposed rule through Sept. 14, 2026. We strongly encourage all physicians, practice managers, and administrators to submit comments to CMS. Individual comments from physicians and practices are an important way to use your voice to bring real people and real-world impact to this proposal.

The below information provides background on the proposed change, and a letter template that can be customized with your practice information and personal experiences and concerns.

• Summary of the Proposed Rule (MSMS summary)
• Submit Formal Comments to CMS regarding CY 2027 Medicare Physician Fee Schedule Proposed Rule here
• MSMS CMS Comment Letter Template

The more physicians and practices who speak up, the stronger our collective voice will be. 

Diabetes remains a significant health concern in Michigan. Nearly 11% of Michigan adults have been diagnosed with diabetes, with prevalence increasing sharply with age, according to the American Diabetes Association.

For these patients, regular A1C testing and active engagement in managing blood glucose are critical. Better glycemic control can help reduce the risk of serious complications, including heart disease, stroke, kidney failure, vision loss and nerve damage.

The HEDIS® "Glycemic Status Assessment for Patients With Diabetes" measure looks at patients ages 18–75 and their most recent A1C or glucose management indicator (GMI), including the percentage with glycemic status below 8% and the percentage in poor control, above 9%.

That makes two things especially important:

1. helping patients improve their A1C
2. making sure they get it checked regularly.

There is room for improvement in The Physician Alliance diabetes quality performance - and every patient interaction can make a difference.

Consider these opportunities:

• Know who is due. Use pre-visit planning and outreach to identify patients overdue for A1C testing.
• Make every result actionable. Discuss what the number means and set realistic, individualized next steps.
• Engage the whole care team. Nurses, pharmacists, care managers and other team members can reinforce education and follow-up.
• Close the loop. Ensure abnormal results lead to timely outreach, treatment adjustments and repeat testing when appropriate.

The Physician Alliance created a Diabetes Management Toolkit that helps practices engage patients in their care - the toolkit includes patient education materials, coding tip sheets, social media graphics and more. Find it here.

Improving A1C control is more than a quality measure. It can mean fewer complications and better outcomes for patients. It also strengthens practice performance on an important HEDIS measure tied to broader quality and value-based care initiatives. In Michigan, a statewide collaborative recently reported that hundreds of patients newly achieved A1C control through focused improvement efforts—proof that consistent attention can move the needle.



Every A1C checked is an opportunity. Every patient engaged is a step toward better health and better quality performance.

Blue Cross Blue Shield of Michigan (BCBSM) is alerting providers of an error impacting chlamydia screening: the HEDIS value set is not updated with the new billing code 87494.

Because of this, BCBSM is providing two options for practices:

• Manually enter the Chlamydia Screening service through a Health eBlue (HEB) entry.
• Wait until November for when the code should be captured via claims.

A reminder that all HEB entries must be inputted by Saturday, January 2, 2027 at 11:59pm

Medical practices are prime targets for phishing scams and fraud - many are also leaving money on the table due to overlooked financial planning gaps.

Join The Physician Alliance for our upcoming member-only live webinar to learn practice tips to spot and stop the scams targeting medical offices today. Plus understand how coordinated personal disability income protection and business overhead coverage create a financial safety net for physicians and their practices - helping to ensure the physician’s paycheck and the office’s ongoing expenses are protected when illness, injury, or other disruptions derail normal operations.

Don't miss this important, must-attend session!

Don’t Let It Happen Here: Scam Prevention and Financial Health for Your Practice

Thursday, Nov. 19, 2026

12-12:45pm

REGISTRATION IS OPEN - Join now!

Speakers:

Lori-Ann Rickard, JD, CDC, Rickard & Associates

Chip Egbert, LifeTime Financial Growth

Brian Kaufman, LifeTime Financial Growth

Care management within a primary care practice can benefit both patients and providers. The Physician Alliance recently hosted webinars related to two important care management programs offered by Blue Cross Blue Shield of Michigan with incentive opportunities for primary care practices.

These webinars are available to TPA's independent primary care practices and can be viewed by logging into the secure member portal - look for the Announcements at the top of the portal homepage or click Webinars on the left-side menu.

Provider-Delivered Care Management (PDCM):

Provider-Delivered Care Management (PDCM) is open to all PCMH practices. PDCM helps better support patients with complex needs and chronic disease management. By strengthening care coordination, PDCM providers demonstrate lower rates of emergency department visits and utilization measures and higher quality scores. Log into TPA's member portal to watch the video to learn about reimbursement opportunities and new eligibility announced by BCBSM.

Psychiatric Collaborative Care Model (CoCM):

In response to the growing problem of access and quality in behavioral health care, BCBSM developed an incentive program to encourage integration of behavioral health into general care. The Psychiatric Collaborative Care Model’s (CoCM) aim is to improve quality, outcomes and access to care while also reducing cost and stigma.

In CoCM, the behavioral health care manager meets with the psychiatric consultant weekly and brings back the psychiatrist’s recommendations to the patient’s primary care physician who then decides whether to change the patient’s treatment for anxiety and/or depression. Learn more about new requirements and eligibility, plus new VBR opportunities in TPA's webinar.

Please note that Henry Ford Health employed primary care practices interested in bringing PDCM and/or CoCM to their practice should contact their practice administrator.

Blue Cross Blue Shield of Michigan (BCBSM) is hosting live webinars to help practices improve coding and documentation. Each webinar focuses on a special topic.

All webinars begin at 12pm.

• Sept. 16: Oncology coding and documentation (30 minutes)

• Oct. 14: ICD-10-CM Updates (45 minutes)

• Nov. 18: OBGYN tips for coding (30 minutes)

• Dec. 9: CPT updates for 2027 (45 minutes)

Register for the trainings here.

Michigan school districts offer insurance-free primary care to beat rising health costs, Bridge Michigan

Blue Cross overhaul of payment rules rattles private practices, Crain's Detroit Business

Study shows more parents are refusing hepatitis B vaccines, vitamin K prophylaxis for infants, Becker's Clinical Leadership

Meta agrees to major changes to Facebook and Instagram as it settles US trial over teen addiction for up to $18bn, The Guardian

Why too many women are prescribed antibiotics for UTIs they don't have, NPR

States try new tactics to bring down high hospital prices, NPR

Health experts cautiously predict milder flu season, Becker's Clinical Leadership

Drugstores say Medicare's $50 obesity drug program is catching on, NPR