The Pulse by Peregrine
April 2026 Revenue & Compliance Update
You’ve Earned the Revenue. Let’s Make Sure You Keep It.
Policy, compliance, and payer updates continue to shape the healthcare revenue cycle. From HIPAA changes to PECOS maintenance, Medicare oversight, and new payer policies, staying informed helps practices protect operations and reimbursement.
Here’s what to know this month.
HIPAA Security Rule Changes Expected in May
Major updates to the HIPAA Security Rule are expected in May 2026, representing the largest revision since 2013. The proposed changes aim to strengthen cybersecurity protections for organizations handling electronic protected health information (ePHI).
While the final rule has not yet been released, healthcare organizations should expect more defined security safeguards, stronger risk management expectations, and increased oversight of vendors.
We’re keeping a close eye on the developments.
PECOS System Maintenance Scheduled for May
PECOS System Maintenance Scheduled for MayCMS will migrate the PECOS provider enrollment system to AWS cloud infrastructure between April 20 and May 4, 2026. PECOS will be temporarily unavailable May 2–3 during the maintenance window. CMS indicates there will be no change to the PECOS login URL or system functionality.
Medicare Improper Payments Reach $28.8 Billion
Medicare Improper Payments Reach $28.8 BillionCMS reported $28.8 billion in Medicare improper payments in 2025, representing 6.6% of fee-for-service spending. Many issues were tied to documentation gaps, coding errors, or services billed at a higher level than documentation supported, which can lead to downcoding or payment adjustments during audits.
For physician practices, the takeaway is clear: strong documentation and revenue cycle oversight are essential to protecting reimbursement.
Read the full update in our blog
New UHC Cardiac Monitoring Policy
UnitedHealthcare has updated its medical policy for implantable loop recorders (ILRs) and wearable heart rhythm monitors, effective May 1, 2026. The policy outlines when ILRs may be considered medically necessary for evaluating suspected cardiac arrhythmias when prior monitoring has not produced a diagnosis. Common indications include cryptogenic stroke with suspected atrial fibrillation, recurrent unexplained syncope, and ventricular arrhythmias. Consumer wearable ECG devices are generally not considered medically necessary for diagnostic use.
View the full policyIndustry Recognition for Peregrine Healthcare
Becker’s Healthcare recently recognized Peregrine Healthcare among the Revenue Cycle Management Companies in Healthcare to Know.
The recognition highlights organizations helping physician practices strengthen revenue performance in an increasingly complex payer environment.
Peregrine Breakroom
Medical Word Scramble
Unscramble the word ➝ N I A L D E
This or That
Which would you rather deal with?
10 claim denials
1 payer audit
Practice Pulse
One of the most common phrases in healthcare revenue cycle:
“We’re still waiting to hear back.”
Peregrine Resource Center
Peregrine tracks payer, Medicare, and compliance changes, so your team stays informed without the overwhelm.
Each month, we highlight what matters most.
For official source updates, we recommend subscribing directly to:
Centers for Medicare & Medicaid
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