CMS proposes raising the ACO benchmark ratchet-relief factor from 50% to 75%
Plus: G2211 becomes a modifier, new ACO-only modifier added, RPM/RTM staffing tightened. The day's rules, money, and enforcement, sourced and tiered below.
Plus: G2211 becomes a modifier, new ACO-only modifier added, RPM/RTM staffing tightened. The day's rules, money, and enforcement, sourced and tiered below.
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American Health Intel
Rules · Money · Medicine · Decoded daily
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| The Service Line |
Monday, July 20, 2026 |
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CMS proposes raising the ACO benchmark ratchet-relief factor from 50% to 75%
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Plus: G2211 becomes a modifier, new ACO-only modifier added, RPM/RTM staffing tightened. The day's rules, money, and enforcement, sourced and tiered below.
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Rule Confidence: High
CMS just proposed rewriting how every Medicare accountable care organization's savings targets get set, raising the factor that decides how much of an ACO's own success shrinks its next benchmark from 50% to 75%.
Part of the CY2027 Physician Fee Schedule rule released July 14. CMS also proposes raising the top ACO shared-savings rate to 60% and capping how far its regional cost projections can miss. Comments close September 14, 2026.
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Why it matters
This rewrites how much of an ACO's own savings get folded back into next year's target, the biggest change to ACO benchmarking math in years. Watch whether the ratchet-relief and guardrail provisions survive comment unchanged by September 14.
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Rule Confidence: High
Medicare's same rule turns a flat primary care payment add-on into a 16% pay bump on the office visit itself, plus a new 32% bump only for doctors inside an accountable care organization.
The catch, remote patient monitoring codes can now only be billed by staff the practice directly employs, not outside vendors, and remote therapeutic monitoring is limited to established patients. Chronic care management is untouched.
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Why it matters
Two Medicare payment changes here: a bigger bonus for complex office visits, and a tighter staffing rule for remote monitoring billing that could squeeze practices relying on contracted monitoring staff. Watch whether the RPM staffing requirement holds through the final rule.
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