The Service Line

In 26 days the Medicare freeze on new hospices and home health agencies expires, and CMS still has not said whether it will renew it. That is the item a cross-specialty operator could least afford to miss from a week in which four of our six Service Line deep dives ran: cardiology on Tuesday, behavioral health on Thursday, home health, hospice and post-acute care on Friday, and surgery and ambulatory surgery centers on Saturday. The Monday and Wednesday issues did not publish, and we would rather say so than imply a full six. Below are the five items worth carrying out of those four issues, each re-checked against a primary source this run, plus one connective insight. Confidence: High on the outage note and on every figure below unless stated.

Home health and hospice: the enrollment freeze ends November 13 and the renewal notice is overdue

The Centers for Medicare and Medicaid Services (CMS) announced six-month nationwide moratoria on new Medicare enrollment for hospices and home health agencies on May 13, 2026. Hospice News reports that CMS said it would give at least 60 days’ notice before expiration, and as of its October 14 story the agency had not said whether it will extend, per Hospice News. Our search of the Federal Register found no extension notice as of today. Existing agencies keep operating and billing. Anyone building or buying a de novo agency should plan for both outcomes: a renewal pushes expansion into 2027, a lapse sends delayed applications to the contractors at once. Confidence: High on the dates; Low on what CMS does, since it can extend by notice at any time. The 60-day commitment rests on trade-press reporting, not the CMS release we reviewed.

Every specialty: the proposed 2027 Medicare conversion factor is $32.84, down 1.68 percent

CMS’s fact sheet on the proposed 2027 physician fee schedule sets the conversion factor, the dollar multiplier on every relative value unit, at $32.84 for clinicians outside qualifying alternative payment models (APMs), down from $33.40, and at $33.17 for those inside them, down 1.19 percent from $33.57. The cut mainly reflects the expiration of the one-year 2.5 percent increase from Public Law 119-21. We found no final rule as of today; last year’s came October 31, so the number could lock within weeks. Cardiology led with it Tuesday, but it prices every office, imaging, and procedure line a physician group bills. Confidence: High on the proposed figures; Medium on timing.

Surgery centers: 92.8 percent of Medicare’s ASC payment errors are documentation, not coding

CMS’s ambulatory surgical center compliance page, using 2024 data, puts the ASC improper payment rate at 14.7 percent, about $656.3 million. Insufficient documentation accounts for 58.8 percent of errors, no documentation for 34 percent, and incorrect coding for 7.2 percent. Compare your own denial reasons to that split; if you look like the national mix, the fix is in the chart, not the coding desk. Confidence: High on the figures; they reflect 2024 data.

Pain procedures: OIG says 72 of 100 sampled sacroiliac joint injection sessions failed Medicare rules

The HHS Office of Inspector General (OIG) estimated in report OAS-25-09-021 that Medicare improperly paid about $15.2 million for 134,526 of 186,842 sessions from October 2023 through September 2024, including 46,711 billed as therapeutic that should have been diagnostic. CMS agreed to education and a fix for diagnostic-versus-therapeutic billing, such as modifier KX education, but declined to adopt a national coverage determination. All three recommendations remain open, with an update due February 2, 2027. The audit covered physician claims, not facility claims, yet it is a documentation roadmap for any pain practice or surgery center that bills the procedure. Confidence: High on the findings; Medium on facility relevance.

Payer-owned care: Optum Health’s margin rose to 3.2 percent as revenue fell 10 percent, and two of our verticals named it a growth line

UnitedHealth Group’s third quarter 2026 earnings release shows Optum Health revenue of $22.9 billion, down 10 percent from $25.4 billion, with earnings from operations of $735 million against $41 million a year earlier. Trade coverage of the October 13 call put both surgery centers and home health among the units Optum says it will deepen in existing markets, which makes the insurer-owned operator both a contracting counterparty and a local competitor. Confidence: High on the financials, which do not break out either line; Medium on what deepening means in practice, since the call comments come from trade reporting.

Connective tissue: regulators in three specialties are testing the paperwork, not the care

The hospice moratorium arrived with data-driven revocations and payment suspensions, the ASC error rate is almost entirely documentation, and the sacroiliac injection audit failed 72 percent of sampled sessions on Medicare requirements. In each case the agency is screening the record, not second-guessing the clinical decision, while the conversion factor above shrinks the revenue that pays for the people who keep the record. An operator in any specialty gets the same return from the same move: audit your own chart documentation against the payer’s published requirements before the payer does, and rank the gaps by dollars at risk. Confidence: Medium, our synthesis of the sourced items above, not a sourced finding.

This Week’s Operator Metrics, At a Glance

• Cardiology: proposed 2027 conversion factor $32.84, down 1.68 percent, per CMS.
• Behavioral health: proposed 2027 intensive outpatient day, $349.52 in a hospital outpatient department versus $139.81 in a community mental health center, per the National Association for Behavioral Healthcare reading of the proposed rule (not re-verified this run).
• Home health and hospice: 44 hospice deals projected for 2026, per the Braff Group via Hospice News (not re-verified this run).
• Surgery and ASCs: 14.7 percent improper payment rate, 92.8 percent of it documentation, per CMS.