The CMS Rate Update Most Practices Miss

Why Most Practices Miss CMS Updates

CMS announces a rate update. You assume it flows through. It often doesn’t — many commercial plans require a contract amendment to adopt new CMS schedules. Without action, you absorb a silent rate decrease while CMS thinks it gave you a raise.

The 30-Day Playbook

1. Identify your top 10 payers and group them: automatic, amendment-required, negotiated.
2. For amendment-required, send the request the month CMS publishes the rule.
3. For negotiated, prepare a one-pager: volume, quality scores, retention.
4. On effective date, audit the first 100 claims to confirm capture.

AileronMD’s briefing flags this every quarter so you don’t miss the window.