Blog
2027 MIPS Final Rule: What Practices Need to Know
Your 2027 MIPS plan now needs a core measure, replacements for any removed improvement activities, and a decision on MVPs. Here's what the final rule changed and what to do first.
Your November MIPS Data Lock Needs a Change Log
Missing encounters and conflicting file versions can derail a MIPS review. Build your November data lock around a dated snapshot, source-to-report reconciliation, and a change log.
When a MIPS Hardship Exception Is Appropriate: An Evidence-First Review
Review 2026 MIPS hardship exception and EUC criteria, documentation, category implications, and the December 31 deadline before applying.
Medicare eCQMs in 2027: A Smaller Reporting Population Still Needs a Strong Data Strategy
CMS's proposed Medicare eCQMs would narrow the reporting population for MSSP ACOs, but fewer patients to aggregate doesn't mean fewer data problems. Test your population, vendors, and scoring tradeoffs before choosing.
Closing Security Gaps Before Year-End
If nobody can locate your 2026 security risk analysis, start with the facts: what exists, what it covers, and who owns the follow-through before December arrives.
MIPS Eligibility Checks: Why Your October Roster Needs a Second Look
Your MIPS roster may look different by October than it did in January. New hires, departures, and billing changes can all affect eligibility. CMS won't publish final 2026 determinations until December, but that doesn't mean you should wait. October is the ideal checkpoint to reconcile your clinician list, billing records, and reporting setup. This post walks through what October means for MIPS eligibility, why the TIN/NPI relationship matters more than a name on a directory, and how to build a tracker that preserves the reasoning behind every decision. Check now, then recheck in December.
Your MIPS Score Arrived. Did Your Reporting Weaknesses Come With It?
Your 2025 MIPS final score is now available from CMS, but a passing score does not tell the whole story. An acceptable result can still hide missing data, manual corrections, vendor gaps, and unclear accountability. This is the moment to look beyond the number and examine the reporting work behind it, before those quiet weaknesses surface elsewhere. Your October review should bring those questions into the room.
MSSP and LEAD Participants: Why CMS’s Proposed MOD2 Replacement for G2211 Deserves Your Attention
CMS proposes replacing G2211 with MOD2, a 32% E/M payment increase for eligible MSSP and LEAD providers. Explore the broader ACO implications.
Your Benchmark Exposure Review Should Start Before the Final Benchmark Arrives
By the time CMS delivers a final benchmark, most of what shaped it is already in motion. Here is a five-step Benchmark Exposure Review ACO leaders can run early, while there is still time to respond.
The $4 Million Reporting Problem That Started Long Before the Penalty
A projected $4M MIPS payment exposure didn't start with one bad score. It started with unowned signals, weak escalation, and validation that came too late.
Seven Compatible Registries Do Not Mean Seven Equivalent Choices
CMS ended ModMed's Qualified Registry status for MIPS Quality reporting starting in 2027. ModMed offers seven compatible registries, but compatible isn't the same as qualified. Here's how to evaluate the real choice.
The 2027 Payment Squeeze: How Practice Expense and Same-Day E/M Changes Could Affect Specialty Revenue
CMS's proposed CY 2027 fee schedule changes could squeeze specialty revenue through revised practice expense rules and reduced same-day E/M payments. Here's how to measure your exposure before the final rule hits.
APP Plus in 2027: Your Reporting Pathway Is Now a Strategic Decision
CMS’s proposed 2027 APP Plus changes could give MSSP ACOs more reporting flexibility, but selecting a pathway is no longer just a quality-reporting decision.
CMS ACCESS Model 2026: What ACOs and Primary Care Practices Need to Know
The ACCESS Model Is Live: Before You Refer a Patient, Map the Workflow
The Next RCM Advantage Starts Before the Claim
Revenue risk often begins long before a claim reaches the billing office. Gaps in provider enrollment, documentation, authorization workflows, quality reporting, interoperability, or evolving CMS requirements can lead to denials, rework, missed performance opportunities, and audit exposure.
There’s No Opting Out of This One: ASM Enters Year One in 2027
Medicare's first mandatory specialist accountability model, the Ambulatory Specialty Model (ASM), takes effect January 1, 2027, targeting cardiologists and spine/pain specialists in roughly 25% of U.S. metro areas. Unlike voluntary value-based initiatives, ASM has no opt-out or hardship exemption. Participating clinicians face payment adjustments from -9% to +9% in Year One, based on quality, cost, care improvement activities, and interoperability metrics. The CY 2027 proposed rule represents the final opportunity to shape operational details before go-live. Affected practices must act now to confirm participant status, build care coordination infrastructure, and prepare for performance scoring that begins January 1, 2027.
The August 2026 Compliance Pressure Map: What Practices Need to Watch
August is not a waiting month for healthcare leaders. With the MSSP RFI-1 deadline on August 5, the ACCESS Model rolling start on August 17, and ASC comments due by August 31, operational action is required now. Separating submission deadlines from decision points is critical to avoid compliance gaps. This pressure map helps ACOs, specialty groups, and ASCs transition from shared awareness to tangible accountability. By assigning ownership and preserving evidence, you can turn the CMS calendar into a controlled operating process rather than a series of administrative reminders. Start building your 2027 strategy before the September PFS deadline.
Active Engagement Is Not a Feeling: How to Prove Public Health Reporting for PI
Active engagement is not a feeling. It's a status your practice must prove. For 2026 MIPS Promoting Interoperability, CMS requires documented evidence for Immunization Registry Reporting and Electronic Case Reporting. A working interface isn't enough. Your practice needs registration confirmations, active engagement levels (Pre-Production/Validation or Validated Data Production), registry communications, and interface status documentation. Optional TEFCA reporting offers bonus points but requires real proof of participation. Don't rely on vendor claims or memory. Build a proof file now while the reporting period is active. Missing documentation creates compliance risk. Check your evidence today.
CMS Just Put a Date on the End of Traditional MIPS
CMS just named the end date for traditional MIPS: CY 2028 is the last performance year. Starting in CY 2029, MVPs become mandatory for every non-APM clinician; the question is no longer if you need an MVP strategy, but which one and by when.
Your PI Proof File Should Be Taking Shape Now. Is It?
Your 2026 Promoting Interoperability score is already being built, which means your evidence file should be taking shape too. A PI Proof File is not a submission-season accessory; it is your practice’s scorekeeper. It moves your team from "we think we are ready" to "we can prove we are ready" by centralizing CEHRT documentation, Security Risk Analysis evidence, public health reporting status, and attestations. Don't rely on good intentions or scattered inboxes. Build a defensible record that connects the dots between your technology, your workflows, and your MIPS submission to ensure you can produce proof when it matters most.