The CMS Rate Update Most Practices Miss

Why Most Practices Miss CMS Updates

CMS may announce a rate update, but a commercial payer’s contract determines whether and when that change applies. Some contracts update automatically, while others require an amendment or use a different fee schedule.

The 30-Day Playbook

1. Identify your top 10 payers and group them: automatic, amendment-required, negotiated.
2. For amendment-required, send the request the month CMS publishes the rule.
3. For negotiated, prepare a one-pager: volume, quality scores, retention.
4. On effective date, audit the first 100 claims to confirm capture.

Keep a contract calendar and confirm the first remittances after each effective date. AileronMD can include that review in the operating discussion.