Traditional MedicareReimbursementHigh impact
2025-11-24 - CMS Empowers Patients and Boosts Transparency by Modernizing Hospital Payments
Medicare/CMS·Payment
Effective date
Jan 1, 2026
We identified it
Jan 12, 2026
Summary
CMS has released the CY 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System final rule, which modernizes hospital payments and enhances price transparency for Medicare beneficiaries. This rule introduces patient-focused reforms affecting hospital outpatient and ASC billing starting in 2026.
Action Required
Before January 1, 2026: Billing team must review the CMS-1834-FC final rule, fact sheets, and press release to understand specific payment changes for hospital outpatient and ASC services. Update billing systems and processes to comply with new payment methodologies and price transparency requirements. Monitor for additional guidance from CMS regarding specific implementation details.