What's Happening?
The Centers for Medicare & Medicaid Services (CMS) has finalized significant changes to Medicare Part B payment policies for 2026. These include two conversion factors for qualifying and non-qualifying
Alternative Payment Model participants, adjustments to practice expense methodology, and a new efficiency adjustment. The changes aim to transition from fee-for-service to value-based care, impacting payment rates for various medical services. The efficiency adjustment will apply to over 7,000 non-time-based services, potentially reducing payments for certain specialties.
Why It's Important?
These changes reflect a shift towards value-based care, aiming to improve efficiency and cost-effectiveness in healthcare delivery. The adjustments could significantly impact reimbursement rates for medical practices, influencing financial planning and operations. As healthcare costs continue to rise, these policy changes are crucial for ensuring sustainable funding and incentivizing quality care. The impact on different specialties highlights the need for medical groups to adapt to evolving payment structures.
