Category Archives: News

New mental health parity rules are now in limbo after the Trump administration halted enforcement, siding with insurers challenging Biden-era reforms. This pause means a surge in prior authorizations, more claim denials, and rising confusion for providers. While federal oversight stalls, 27 states still enforce parity laws. Pyramids Global helps providers stay compliant with real-time tools like Parity Checker, Denial Radar, and state-specific coding. Their stance: treat the rules as active until officially revoked. In this legal gray zone, smart billing and proactive compliance are key to protecting your revenue.

2026 Medicare Advantage changes are here: CMS approved a 5% pay boost for plans, insulin caps, and prior auth rule tweaks. But for doctors, it’s more frustration—frozen fees, complex appeals, and new billing traps. Pyramids Global helps providers fight back with automated tools like MA Claim Maximizer, Auth Tracker, and AI-driven denial defense systems. From social risk coding to high-risk patient targeting, we turn Medicare upheaval into opportunity. As clinics brace for another tough year, we’re helping them stay profitable, compliant, and one step ahead of payer red tape.

The Biden administration’s CMS prior authorization reforms aim to reduce patient delays but pose billing risks for providers. Uniform rules risk payer misinterpretation, while AI automation may trigger denials (e.g., knee replacements for seniors). With 73% of plans historically ignoring voluntary rules, Pyramids Global ensures compliance via real-time payer updates, AI-optimized claims (cutting appeals by 62%), and auto-modifier alerts. Their clients avoided 2023’s 41% denial spike and saw 2025 denials drop 7% versus others’ 29% rise. “CMS plays chess. We teach 3D chess,” says Pyramids. Clinics can’t afford delays—proactive adaptation is critical.

2.6% payment increase for inpatient rehab facilities in 2026 sounds promising, but hidden compliance risks could erase gains. CMS’s update includes stricter audits, tweaked outlier thresholds, and changes in quality reporting requirements. Facilities must juggle case-mix weight shifts, wage index updates, and new submission rules. Pyramids Global helps providers turn these challenges into opportunities by offering gap alerts, penalty shields, case-mix optimization, and future-proofing strategies. Don’t let your boost slip away—partner with Pyramids Global to maximize revenue and stay ahead of every CMS change.

CMS finalizes a 5.06% Medicare Advantage rate hike for 2026, surpassing the earlier 2.23% proposal—fueling insurer gains but pressuring providers. While payers enjoy a $25B boost, physicians face pay cuts, tighter audits, and tougher risk adjustment models. Pyramids Global steps in with coding audits, denial defense, and equity-focused workflows to protect clinics from clawbacks and lost revenue. With new drug caps, shifting star ratings, and outcome-based reimbursements, providers can’t afford to fall behind. Pyramids Global ensures you’re not just compliant—but always three moves ahead.