If you bill Medicare or Humana Medicare Advantage, there are several updates in effect right now that affect your claims, your compliance, and your reimbursement. Here is a quick rundown of what you need to know.
Want to HEAR these changes in stead of read – scroll down for the video!
1. Humana Medicare Advantage: New $5 Fee for Paper Claims
Humana has implemented a $5 fee per paper claim submission. If your office is still submitting paper claims to Humana, that fee will be deducted from your reimbursement. Electronic submission is the straightforward way to avoid this charge. See the links below for the full policy.
2. Updated Medicare Fee Schedule (Effective April 15)
CGS posted an updated Medicare fee schedule effective April 15. If you have noticed your reimbursements coming back slightly different than expected, this is the likely reason. The updated fee list is available on the KAC website, and you can also check the CGS website directly for the most current rates.
LINK: https://thekac.org/2026/04/15/updated-medicare-fee-schedule-4-1-2026/
CGS Website: https://cgsmedicare.com/index.html
3. New ABN Is Now in Effect
The updated Advance Beneficiary Notice of Noncoverage (ABN) is now required. If your office is still using an older version of this form, you need to update immediately. Using an outdated ABN creates a compliance exposure that is entirely avoidable. KAC members can download the current version from the KAC website.
LINK: https://thekac.org/2026/03/16/table-talk-new-abn-released-transition-required-by-may-12-2026/
4. Medicare Modernization Legislation: Cosponsor Update
Three bills of significant importance to chiropractic are moving in Congress:
- HR 539 (Medicare coverage modernization): 160 cosponsors in the House
- S 106 (Senate companion): 15 cosponsors
- HR 4204 (Patient choice and opt-out): 15 cosponsors
These numbers reflect real momentum. KAC will continue to keep you updated as these bills advance.
LINK: http://www.thekac.org/BetterMedicare
HR539: https://www.congress.gov/bill/119th-congress/house-bill/539
S106: https://www.congress.gov/bill/119th-congress/senate-bill/106
HR4204: https://www.congress.gov/bill/119th-congress/house-bill/4204
5. Controlled Substance Use Disorder Privacy Rules: Compliance Reminder
Updated federal privacy rules governing records related to controlled substance use disorder treatment are in effect. Your office should be using compliant forms and language. KAC members have access to templates and model forms on the KAC website.
6. Medicare Revalidation: Do Not Miss Your Window
This one bears repeating. We are hearing from an increasing number of providers who have missed their Medicare revalidation deadline, and the process to fix it is significantly more time-consuming than simply staying on top of it.
Our recommendation:
Set a recurring calendar task every month or quarter to check your revalidation status. It takes about one minute, and it can save you a significant amount of administrative pain.
LINK: https://data.cms.gov/tools/medicare-revalidation-list
7. HETS EDI Enrollment: Deadline May 11, 2026
(Still Developing – stay tuned for more details!)
DEADLINE: May 11, 2026 | We are still learning more about the specific impact on chiropractic providers. Check back for updates.
CMS is transitioning to a new HETS trading partner management system on May 11, 2026. HETS (the HIPAA Eligibility Transaction System) is the system your vendors and clearinghouses use to verify Medicare beneficiary eligibility before submitting claims.
Starting May 11, 2026, every provider NPI used by a vendor or clearinghouse must have an active HETS EDI enrollment. Without it, eligibility requests will be rejected.
What you should do now:
- Contact your billing vendor or clearinghouse and ask whether your NPI has an active HETS EDI enrollment.
- If you handle your own billing, review the CMS enrollment page linked below and complete enrollment through the appropriate Medicare Administrative Contractor (MAC). For Kentucky chiropractors, that is CGS.
- Check back with KAC as we continue to gather more information specific to chiropractic providers.
LINK: CMS HETS EDI Enrollment Page: cms.gov – HETS EDI: How to Enroll
Resources and Links
- LINK: Humana paper claims policy – https://thekac.org/2026/03/27/humana-medicare-advantage-new-paper-claim-administrative-fee-effective-july-1-2026/
- LINK: KAC updated Medicare fee schedule – https://thekac.org/2026/04/15/updated-medicare-fee-schedule-4-1-2026/
- LINK: CGS website – https://cgsmedicare.com/index.html
- LINK: KAC ABN download – https://thekac.org/2026/03/16/table-talk-new-abn-released-transition-required-by-may-12-2026/
- LINK: KAC controlled substance privacy templates – https://thekac.org/2026/02/16/new-federal-privacy-rules-for-substance-use-disorder-records-what-kentucky-chiropractors-should-know/
- LINK: Medicare revalidation check – https://data.cms.gov/tools/medicare-revalidation-list
- LINK: CMS HETS EDI Enrollment: cms.gov/HETS-EDI-Enroll
Questions? KAC members can reach us at kac@thekac.org. Not yet a member? Visit thekac.org to learn more.
