On July 15, the Centers for Medicare & Medicaid Services (CMS) released the CY 2026 Proposed Rule for the Medicare Outpatient Prospective Payment System (OPPS). The proposed rule introduces several significant policy changes that will impact hospitals and ambulatory surgical centers (ASCs) beginning Jan. 1.  From updates to the 340B payment policy and ambulatory payment classifications (APCs) to the elimination of the Inpatient-only (IPO) list and expanded reporting requirements, the CY 2026 OPPS rule is one of the most comprehensive updates in recent years.   CMS projects an overall $1.61 billion increase in OPPS payments before accounting for the 340B remedy offset, which is expected to reduce payments by $1.1 billion, resulting in a net increase of approximately $510 million.  This blog post breaks down the most important proposed changes, financial impacts and reporting requirements so your organization can prepare for compliance and optimize reimbursement strateg...

On July 14, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2026 proposed rule for the Medicare Physician Fee Schedule (PFS) . This annual update outlines changes to physician payment rates, policy refinements and adjustments to programs that affect healthcare providers nationwide. If finalized, the proposed updates will take effect for services provided on or after Jan. 1, 2026.  The rule introduces appreciable revisions that impact payment methodology, practice expense allocations and data sources used for setting reimbursement rates. Below are the most critical takeaways for healthcare providers and stakeholders.  Key proposed changes to the CY 2026 Medicare PFS proposed rule  CMS’s proposed changes address several major policy areas, including:  payment rate updates;  Relative Value Unit (RVU) updates;  GPCI updates;  Rural Health Clinics and Federally Qualified Health Centers;  Ambulatory Specialty Model...

On June 30, Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Home Health Prospective Payment System (HH PPS) proposed rule . This annual rule outlines significant changes to Medicare home health payment policies, including rate adjustments, Patient-Driven Groupings Model (PDGM) recalibration, quality reporting updates and value-based purchasing modifications.  For home health agencies (HHAs), this year’s proposed rule carries major financial and operational implications. CMS estimates an overall $1.135 billion decrease in aggregate payments in CY 2026 compared to CY 2025, largely driven by permanent behavioral adjustments, temporary payment recoupments and changes to outlier payment thresholds.  In addition to payment updates, the rule introduces policy revisions to the Home Health Value-Based Purchasing (HHVBP) model, face-to-face encounter requirements, provider enrollment safeguards and durable medical equipment regulations.   Ove...