Last Monday morning, our Slack lit up with a headline: “CMS floats 3.8% Medicare pay bump for 2026.”
For about 30 seconds, we celebrated. Then we opened the rule and saw the line that matters:
“…payment for codes that are not based on physicians’ time will decrease by 2.5 %.” (Axios)
Cue record scratch.
Headline Math vs Real-World Math
+3.8 % applies mainly to time‑based E/M visits (think family medicine or psych.)
‑2.5 % hits the work RVUs of almost every procedure code our clients rely on: infusion, imaging, skin grafts, and outpatient surgery. (American Hospital Association, American College of Cardiology)
If your practice is procedure-heavy, the average infusion for Remicade that used to net your practice $2,000 is now losing $50 per dose. Multiply that across monthly volume, and the “raise” quickly becomes a six‑figure haircut.
Why the Timing Could Not Be Worse
Medicare cuts are painful in any year, but doing it while the Fed keeps overnight rates parked between 4.25 % and 4.50% magnifies the squeeze. Every extra day those claims sit in limbo costs more in borrowing or missed opportunity. (Reuters)
Three Moves to Get Ahead of the Cut
- Model the Dip Now
Run a quick scenario: take your top ten CPTs, shave off 2.5 percent, and project a 90-day reimbursement delay. The delta is your new liquidity gap.
- Accelerate What You Already Earned
Converting aged AR into same‑day cash lets you sidestep both the rate hike and the CMS haircut. You keep reserves intact and fund growth instead of plugging holes.
- Speak Up Before September 12
CMS is still in the comment period. Specialty societies will file letters, but individual practice stories are also important. A two-paragraph submission explaining how a 2.5 percent cut affects patient access carries weight. (Axios)
The Bottom Line
CMS gave primary care a raise and handed the bill to procedure-driven groups. Waiting for Congress to fix it is not a strategy. Leveraging your earned claims today keeps you agile tomorrow—no matter what the final rule looks like.
If you’d like to see what an AR advance would look like against your fee schedule, let’s talk.
We can run the numbers in one quick call and show exactly how much margin you can put back into patient care and growth.