Tag: Advanced Alternative Payment Models (APMs)
Final 2026 Medicare Conversion Factors: What Providers Need to Know
Understanding the difference between QP and non-QP conversion factors
Each year, the Centers for Medicare & Medicaid Services (CMS) finalizes updates that impact Medicare reimbursement under the Physician Fee Schedule (PFS). One of the most important updates is the Medicare Conversion Factor (CF) — the dollar amount used to convert Relative Value Units (RVUs) into the final payment amount.
For Calendar Year (CY) 2026, CMS finalized two separate conversion factors:
One for Qualifying Participants (QPs) in Advanced Alternative Payment Models (Advanced APMs)
One for Non-Qualifying Participants (Non-QPs)
This distinction is important because it directly affects reimbursement rates depending on a provider’s participation status in the Quality Payment Program (QPP).
Qualifying Participants (QPs)
A provider becomes a QP by meeting specific thresholds for participation in Advanced APMs, such as having a certain percentage of payments or patients through eligible Advanced APM arrangements.
Key point: QPs receive a more favorable conversion factor update than non-QPs.
Non-Qualifying Participants (Non-QPs)
Providers who do not meet QP thresholds—or who participate in MIPS instead—fall into the non-QP category.
Bottom Line:
The Final 2026 Medicare Conversion Factors reinforce a major policy direction: CMS continues to differentiate payment updates based on participation in Advanced APMs.
Understanding whether your clinicians are QPs or non-QPs is essential for accurate reimbursement forecasting and strategic planning.
Conversion Factor:
- $33.57 for qualifying alternative payment model (APM) participants (QPs)
- $33.40 for non-QPs
- An increase of 3.77% for QPs and 3.26% for non-QPs over the 2025 rates
- Includes 0.75% increase for QPs and 0.25 for non-QPs
- 0.49% positive budget neutrality adjustment
- 2.50% increase from the OBBBA for 2026
Two New Files Added
Annual Regulatory Burden Report, MGMA, October 2021
[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2021/10/MGMA-Annual-Regulatory-Burden-Report-October-2021.10.29.pdf” download=”all” viewer=”google”]
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