Reimbursement: what changes, and when

Payment policy becomes useful when a team knows which change applies to which date of service. National updates are only part of that calculation. The service, setting, geography, and contract still determine what a provider is paid.

Physician payment: in effect for 2026

For calendar year 2026, CMS set two Physician Fee Schedule conversion factors: $33.57 for qualifying Advanced APM participants and $33.40 for other physicians and practitioners. Both are rounded figures from the CMS final-rule summary.

These are inputs to a payment calculation, not prices for an office visit. Relative value units, geographic adjustments, and service-specific policies determine the final amount. A percentage change in the conversion factor will not necessarily equal a practice’s overall revenue change.

Hospice: the next payment year

The FY 2027 hospice final rule sets a 2.3% payment update and a $36,174.75 aggregate cap amount for the payment year beginning October 1, 2026. Hospices that do not meet quality-reporting requirements face a four-percentage-point reduction to the update.

The rule also makes the hospice election-statement addendum mandatory for all Medicare beneficiaries at election. The addendum explains conditions, services, items, or drugs the hospice considers unrelated to the terminal illness and related conditions.

Turn the update into an operating plan

Identify the effective date first. Then confirm the applicable CMS payment files, Medicare contractor guidance, and the contract language for any managed-care arrangement. A Medicare benchmark and a negotiated contract are separate inputs.

For a clinical leader, the useful question is what these changes mean for access, staffing, documentation, and continuity. The financial review should lead to a concrete plan for the people delivering care.