Healthmonix Advisor

The frantic pace, high-stakes decisions, and unpredictable patient flow of the emergency department make it a unique and challenging environment in healthcare. For years, the Merit-based Incentive Payment System (MIPS) program has presented a formidable obstacle for emergency physicians, and now the Cost category will have a measure just for emergency medicine in your 2024 feedback. This part of MIPS, which assesses the total cost of care for patients, can feel disconnected from the realities of emergency medicine, where the primary goal is rapid stabilization and appropriate disposition, not cost control. 

On July 10, 2025, CMS released the CY 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule. While CMS characterized 2026 as a “stabilization year,” the Proposed Rule brings several notable updates to the Merit-Based Incentive Payment System (MIPS), particularly around MIPS Value Pathways (MVPs), the Cost performance category, and registry participation.  

These changes are crucial for providers aiming to protect their reimbursement, streamline reporting, and improve performance. 

As CMS continues to evolve value-based care, the Ambulatory Specialty Model (ASM) in the 2026 Physician Fee Schedule (PFS) Proposed Rule represents a landmark opportunity for specialists who have historically been excluded from broader accountable care models like MSSP and ACO REACH. 

In 2025, Medicare introduced three new Advanced Primary Care Management (APCM) codes —G0556, G0557, and G0558 — to support streamlined, comprehensive care for patients with chronic conditions. These codes not only simplify billing but are also tied to performance reporting under the Merit-based Incentive Payment System (MIPS). This post breaks down what providers need to know. 

One theme emerged loud and clear at the NAACOS Spring 2025 Conference: transformation isn’t just about systems. It’s about people, collaboration, and actionable workflows. 

Healthcare organizations nationwide are navigating the complexities of value-based care (VBC). VBC success is measured in procedures performed and outcomes achieved. It requires coordination between technology, teams, and providers. 

Many organizations are struggling to close the gaps.

Last week, I had the opportunity to join healthcare executives, clinical leaders, and innovators from across the country at the Becker’s Hospital Review 15th Annual Meeting. Every year, this event captures the current temperature of healthcare transformation — but this year felt different. There was a sharpened urgency in the air and a deeper willingness to challenge long-standing norms. 

Across sessions, one question echoed consistently: How do we design a healthcare system that truly delivers value — to patients, providers, employers, and communities? 

The Transforming Episode Accountability Model (TEAM) is set to revolutionize how hospitals coordinate care for Medicare beneficiaries undergoing high-risk, high-volume surgical procedures. Slated to start in January 2026, this 5-year, mandatory model will focus on improving patient care quality while controlling costs.  

Here’s an in-depth look at what TEAM entails and its potential to transform the healthcare landscape. 

In 2025, CMS launched a significant evolution in its commitment to primary care: the Advanced Primary Care Management (APCM) codes. These codes — G0556, G0557, and G0558 — are designed to simplify billing, support patient-centered care, and advance health equity for patients with chronic conditions. 

But there’s a catch. These codes come with new requirements, including participation in the Value in Primary Care MIPS Value Pathway (MVP) for eligible clinicians. 

In this post, we’ll break down: 

• What APCM codes are 

• Who can bill them 

• How they differ from existing care management codes 

• What’s required for MIPS compliance 

• What happens if you don’t report 

• What steps your practice should take next 

As value-based care matures, MSSP ACOs face mounting complexity in quality reporting — across EHRs, payers, and evolving CMS requirements. At Healthmonix, we don’t just promise solutions. We’ve already delivered them — at scale, across diverse ACOs, and in direct partnership with forward-thinking healthcare leaders. 

If you’re an eligible clinician participating in MIPS, your 2024 Cost category score will be calculated after submission — and the results may come as a surprise. With Cost accounting for 30% of your total MIPS score, it’s no longer an afterthought. It’s a major factor in your final performance.