The 2026 Medicare physician updates are here and doctors need to know what changed. The new rules come in on January 1, 2026. These updates will affect how you get paid and how you report quality measures. We will break down the important parts so you can prepare your practice.
Payment Increases Are Small but Helpful
Your conversion factor is going up this year. If you work in an advanced payment model, you will see a 3.77% increase. The conversion factor will be $33.5675. For other doctors, the increase is 3.26% with a factor of $33.4009.
Medicare calculates payments using Relative Value Units. There are three types. Work RVUs cover your time and skill. Practice expense RVUs cover overhead like rent and staff. Malpractice RVUs cover insurance costs. Each type gets adjusted for where you practice. Then everything gets multiplied by the conversion factor.
The small increase shows CMS wants to make value-based care more appealing. If you are still doing fee-for-service, good MIPS adjustments could help you decide whether to switch models.
Reporting Requirements Stay the Same
The performance threshold stays at 75 points through payment year 2030. This means you can plan without worrying about constant changes. The 2026 Medicare Physician Updates keep things stable for MIPS reporting.
CMS is still moving toward MIPS Value Pathways. They added six new options for different specialties. The Quality Measure Inventory now has 190 measures. Five new measures were added and ten old ones were removed. These are small changes, not a complete overhaul.
Prime Well’s has seen that practices do better when they know what to expect. The stable requirements let you focus on better patient care instead of chasing new rules every year.
Telehealth Rules Are Now Easier to Understand
CMS changed how telehealth services get approved. They removed the old system of provisional versus permanent services. Now a service qualifies if it works well through video calls. Some services can use audio only calls when needed.
This gives you more options. You can use telehealth when it makes clinical sense. For rural practices or patients who cannot travel easily, this helps a lot.
You need to track whether visits happen in person or through telehealth. This matters for quality reporting and cost tracking. Make sure your system can record this information correctly. The 2026 Medicare Physician Updates require better data tracking for telehealth visits.
Care Coordination Gets Better Support
The 2026 Medicare Physician final rule makes care coordination easier. Rural Health Clinics and Federally Qualified Health Centers can now get standalone payments for coordinating care. CMS also approved using video calls for direct supervision of some services.
This helps you reach more patients. You can use hybrid models to coordinate care. Patients in rural areas or places with fewer resources can get better access.
Your billing data needs to connect with your EHR logs and quality reports. CMS wants practices to work more efficiently. This means your data systems need to talk to each other. Prime Well Med Solutions helps practices connect these systems so everything works together.
ACO Timeline Is Getting Faster
Accountable Care Organizations face new timelines. Track 1 BASIC ACOs now have five years to move to two-sided risk instead of seven years. This applies to agreements starting on or after January 1, 2027.
Two-sided risk means you share both savings and losses. CMS wants ACOs to move away from upside only models. Before you only got bonuses for saving money. Now you could lose money if the results are poor.
The minimum beneficiary requirement stays at 5,000. CMS added some flexibility for years when you fall below that number. This helps smaller ACOs and rural organizations stay involved.
The health equity adjustment is gone from ACO quality scores starting in Performance Year 2026. CMS is also updating the APP Plus measure set to reduce overlap.
ACOs need better attribution processes and quality measurement. CMS wants to see value and coordination across different care settings. The 2026 Medicare Physician Updates push ACOs to prepare faster for risk based arrangements.
What Your Practice Should Do Right Now
Look at your data systems first. Can your systems connect billing, clinical notes, and quality reporting? If not, fix this now.
Check your measure portfolio next. With MIPS reporting stable through 2030, you have time to match your measures with MIPS and ACO needs.
For telehealth, track how visits happen. This affects your quality scores and cost measures. If you use hybrid care coordination, document everything properly.
If you are in an ACO, plan for the faster move to two-sided risk. Review your attribution process and how you measure quality. You need both to do well under the new timeline.
Important Points About the 2026 Medicare Physician Updates
The changes are not big, but they obviously matter. Payment increases are modest. Reporting stays steady. Telehealth becomes more flexible. Care coordination gets more support. ACOs face tighter deadlines.
CMS clearly wants integrated care that rewards coordination and quality. To succeed in 2026, you need connected systems and good data. You need to show the value you deliver with clear information.
Our MIPS reporting company works with practices on these changes. We help connect your data and make quality reporting easier. We get you ready for value-based care. The new rules start January 1, 2026, so prepare now.
Healthcare keeps changing, but the path is clear. Better integration, more responsibility, and stronger rewards for quality care are coming. Practices that improve their systems and focus on coordination will do well. The 2026 Medicare Physician Updates show you what to do. Now you need to take action and get your practice ready for these important changes.
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