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You’re not alone if you don’t know how to confirm a provider's advanced alternative payment model particpation status.That information will tell the conversion factors for their physician fee schedule and anesthesia services in 2026 and beyond.
 
 
Medicare’s rules for prior authorization requests (PAR) for certain procedures performed in the hospital outpatient department (HOPD) are designed to prevent abusive utilization and billing. The Dec. 8 issue of Part B News reveals a skyrocketing rate of prior authorization requests.
 
 
CMS will expedite the next National Correct Coding Initiative update to stop denials when a provider reports administration of the COVID-19 vaccine and another vaccine code for the same patient on the same day.
 
The Continuing Appropriations and Extensions Act, 2026 (CAE 2026), reactivated the COVID-19 telehealth waivers until Jan. 30, 2026. Better still, the CAE 2026 closed a potential telehealth payment gap by backdating the extension to Sept. 30, 2025.
 
Your providers will see higher conversion factors (CF) in 2026, with a 3.8% boost to those participating in qualifying alternative payment models (APM) and a 3.3% increase for everyone else. Yet a yawning gap in reimbursement levels will confront practices in 2026, depending on whether your providers deliver care in the non-facility or facility setting.
 

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