Medicare reimbursements may be lower in 2026 because of changes to work RVUs, facility-based practice expenses, service-specific payment rates, and claim-level adjustments. Although CMS increased the conversion factors, individual practices may receive less depending on their specialty, CPT codes, service location, and billing accuracy. Identifying the exact cause requires a Medicare reimbursement analysis and payment review.
What Is Reducing Medicare Payments in 2026?
Several changes can affect physician reimbursement:
- Conversion factors: CMS finalized $33.57 for qualifying APM participants and $33.40 for other practitioners, but these increases do not guarantee higher payments for every service.
- Work RVU adjustment: A 2.5% efficiency adjustment applies to eligible non-time-based services, potentially reducing reimbursement for affected procedures.
- Facility practice expenses: Changes to indirect practice expense calculations create downward payment pressure for facility-based services, with an estimated 7% overall reduction in physician facility-setting payments.
- Sequestration: The statutory 2% Medicare payment reduction can further affect applicable fee-for-service payments.
- Billing problems: Incorrect CPT or ICD-10 coding, missed charges, inadequate documentation, and claim denials can create additional revenue losses.
How Can Medical Practices Improve Medicare Collections?
Start by comparing your top 20 billed CPT codes against applicable 2026 fee schedule amounts. Review Medicare remittance advice, payment posting, eligibility verification, prior authorization, claim scrubbing, and denial patterns. Monitor outstanding balances through effective AR Management and investigate potential underpayments before applicable filing and appeal deadlines.
For practices experiencing recurring discrepancies, medical billing audit services can help identify coding and payment issues. The Medicator’s also provides medical billing services and revenue cycle management support to strengthen billing accuracy and collection workflows.
Expert recommendation: Do not assume every payment reduction is a CMS cut. Compare expected reimbursement with actual payments at the service-code level before deciding what needs correction.
If your Medicare collections are declining, request a free practice analysis from The Medicator’s at (888) 277-1460 to identify potential billing weaknesses and determine the appropriate next steps.
