Finalized Policies in the CY 2026 Medicare Physician Fee Schedule Final Rule

November 17, 2025Garrett SchmittCoding, HCC, MVPs, Risk adjustment coding

The 2026 Medicare Physician Fee Schedule Final Rule is Here The 2026 Medicare Physician Fee Schedule (MPFS) Final Rule is out and you’re wondering what it means for you. It’s packed with finalized updates on MIPS, six new MVPs, easier ACO reporting, a new program model, and acknowledgment of the extensive feedback received on multiple…

Beyond Rising Cut Points: How to Build a 2026 STARs Adherence Strategy Now

November 15, 2025Garrett SchmittCoding, HCC, MVPs, Risk adjustment coding

You cannot control CMS raising cut points. But you can control how you respond. The 2026 requirements are clear. CMS is implementing risk-adjusted measures focused on Social Determinants of Health. The new Excellent Health Outcomes for All reward ties STAR ratings exclusively to performance among your hardest-to-engage members—Dual-Eligible, Low-Income Subsidy, and disabled populations. These changes…

CMS 2023 Proposed Rule Accelerates ACOs, MVPs

July 12, 2022Garrett SchmittACOs, CMS, MVPs, Physician Fee Schedule

CMS just set off summer fireworks, amping up incentives to adopt Value-Based Care in its just-released, 2,066-page 2023 Proposed Physician Fee Schedule Rule. By encouraging formation of new ACOs, the Proposed Rule establishes a pathway to expand beneficiaries’ access to accountable care. Last year, CMS committed that every Medicare beneficiary will be in an accountable…

The 2022 CMS PFS And QPP Proposed Rule: 7 Things To Know

July 19, 2021Garrett SchmittNo Comments2022 PFS, ACOs, CEHRT, CMS, COVID-19, data exchange, health equity strategies, Medicare, MIPS Value Pathways, MSSP, MVPs, patient-reported outcomes, Physician Fee Schedule, QPP Proposed Rule, Quality Reporting

After the 2020 election, we predicted seven trends to expect in Value-Based Care. Our forecasts were right on track. Last week the Biden Administration released its first Physician Fee Schedule and Quality Payment Program Proposed Rule, a 1,747-page document that promotes restructured value-based care initiatives. As we predicted, it recognizes both a significant health equity…

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