From the CMS QPP Updates Newsletter:

From MLN Connects Newsletter, Special Edition: October 1, 2025:

What’s Changing with Medicare Telehealth?

1. Fewer Services Will Be Covered
   Many telehealth services that were allowed during the COVID-19 emergency will no longer be covered unless Congress acts. This mostly affects non-mental health services.

2. As prior to COVID -19 Flexibilities, Where the Patient Is Matters
   Patients must be in rural areas or certain medical facilities to get Medicare-covered telehealth (except for mental health care).
   Services from home will not be covered for most types of care.

3. Mental Health Services Are Still Covered
   Telehealth for mental and behavioral health can still be done from home.
   However, patients must have an in-person visit at least once every year to keep using telehealth for these services. 

4. Advance Notice May Be Needed
   If a provider offers a telehealth service that Medicare won’t pay for, they may need to give the patient an Advance Beneficiary Notice to explain the cost.

5. Some Providers Can Still Use Telehealth Freely
   Providers in Medicare Shared Savings Program ACOs can continue offering telehealth without location limits, even after October 1.

    

   Source: https://www.cms.gov/medicare/payment/fee-for-service-providers 

This edition of the newsletter was sent to subscribers on October 1.  You are encouraged to subscribe to updates from CMS. Archived editions of the newsletter are available here.

From CMS Quality Payment Program Newsletter:

As previously announced (QPP listserv sent 7/25/2025), there was a delay with receiving some of the final Medicare claims data needed to calculate cost measures, which is delaying the release of MIPS final scores for the 2024 performance year and the Targeted Review period.

• We’re currently targeting mid-September for releasing 2024 MIPS final scores and opening the Targeted Review period.

MIPS payment adjustments for the 2026 MIPS payment year will be released approximately one month after the release of final scores. The Targeted Review period will close 30 days after the release of MIPS payment adjustments. From now until mid-September, you’ll continue to be able to access measure and activity-level scores for the data you reported during the submission period. However, performance period benchmarks are part of final scoring and won’t be available until final scores are released. In the meantime, we encourage you to confirm your MIPS eligibility and review the following scoring resources so that you’re prepared to understand your scores when they’re released. To confirm your eligibility for a MIPS payment adjustment, enter your National Provider Identifier (NPI) on the QPP Participation Status Look Up tool (check “PY 2024”) or sign into the QPP website and navigate to the Eligibility & Reporting page on the left hand navigation. Review pages 12 – 16 of the 2024 MIPS Eligibility and Participation Guide (PDF) for more information about what you see.

Review these scoring resources:

• 2024 Traditional MIPS Scoring Guide (ZIP, 6MB)
• 2024 APP Scoring Guide, included in the 2024 APP Toolkit (ZIP, 2MB)
• 2024 MVPs Implementation Guide (PDF, 1MB)

Today we bring you updates from the latest CMS QPP Newsletter for Small Practices:

CMS Proposes Policy Changes for Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) has issued its Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule, which includes proposed policies for the Quality Payment Program (QPP).

The Notice of Proposed Rulemaking (NPRM) includes proposals for the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs), as well as several Requests for Information (RFIs).

Specifically, we’re proposing policies that:

• Continue the transformation of MIPS through MIPS Value Pathways (MVPs).
• Are responsive to feedback and concerns raised by interested parties.
• Maintain stability within the MIPS program through the established performance threshold.

2026 Policy Proposal Highlights

Key QPP policies that we are proposing in the CY 2026 PFS Proposed Rule include:

• Introducing 6 new MVPs for the 2026 performance year that are related to diagnostic radiology, interventional radiology, neuropsychology, pathology, podiatry, and vascular surgery.
• Introducing a 2-year informational-only feedback period for new cost measures, allowing clinicians to receive feedback on their score(s) and find opportunities to improve performance before a new cost measure affects their MIPS final score.
• Maintaining the current performance threshold policies, leaving the performance threshold set at 75 points through the 2028 performance year.
• Introducing Qualifying APM Participant (QP) determinations at the individual level, in addition to existing determinations at the APM entity level.

Overview of RFIs

We are also seeking feedback on RFIs about the following topics:

• Establishing Core Elements for MVPs, to require reporting on key quality measures within each MVP.
• Establishing a process to assign clinicians to an MVP, to facilitate the most relevant reporting for their scope of care.
• Transitioning to FHIR-based electronic clinical quality measure (eCQM) reporting in quality reporting programs.
• Understanding the current environment, including challenges, with collecting and exchanging high-quality healthcare data.
• Changing requirements for the Query of Prescription Drug Monitoring Program (PDMP) Measure and Performance-Based Measures in the Public Health and Clinical Data Exchange Objective.
  

The Center for Medicare and Medicaid Services (CMS) has announced it is suspending eight improvement activities for the 2025 performance year.

The suspension is in accordance with the Merit-based Incentive Payment System (MIPS) Improvement Activities Suspension Policy finalized in the CY2021 Physician Fee Schedule final rule.  CMS intends to propose removing these improvement activities in future rulemaking.

MIPS Improvement Activities Suspended for PY 2025

CMS says that clinicians should select other improvement activities to complete.  However, if any of the suspended improvement activities have already been completed or were in the process of being completed, clinicians will still be able to attest to completing them and receive credit.  Please review the 2025 Improvement Activities Inventory for available improvement activities.

Visit the QPP website for more information.

Source: Improvement Activities Suspension Announcement, Small Practices Newsletter, 2025

The Centers for Medicare & Medicare Services (CMS) has released Merit-based Incentive Payment System (MIPS) performance feedback and final scores for the 2023 performance year and associated MIPS payment adjustment information for the 2025 payment year.

CMS identified phishing scams for medical records. This may include scammers faxing you fraudulent medical records requests to get you to send patient records in response; see example (PDF).

Do you perform Clinical Laboratory Improvement Amendment (CLIA) waived tests in the lab at your  practice?

Make sure your certificate is up to date, and your coding and billing practices are too!

The Centers for Medicare & Medicaid Services (CMS) opened data submission for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in the 2023 performance year of the Quality Payment Program (QPP) on January 2, 2024. Data can be submitted and updated until 8:00 p.m. ET on April 1, 2024.

In a previous Practice Support blog post, we highlighted basic information and eligibility criteria for the Making Care Primary Model.  In response to stakeholder feedback, CMS extended the application deadline by two weeks; the new deadline is Thursday, December 14 at 11:59 p.m. EST.