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News update

Apr 14, 2026

LEAD: CMS Brings Greater Flexibility to Original Medicare, Similar to Medicare Advantage

The CMS Innovation Center has issued a request for applications (RFA) for the Long-term Enhanced ACO Design (LEAD) model. This is a new 10-year accountable care program set to start in 2027. It updates how ACOs are benchmarked, paid, and structured and brings some features of Medicare Advantage into original Medicare. Applications are due by May 17, 2026.

For healthcare stakeholders, LEAD changes how accountable care programs may be approached. Its design around benchmarks, risk, and patient incentives can affect financial results, care delivery, and competition between ACOs and Medicare Advantage plans.

Services

Credentialing

Credentialing is the rigorous process of verifying a healthcare provider’s qualifications, including their education, training, licenses, and clinical experience. This service ensures that practitioners meet the high standards required by insurance networks and hospitals to provide care and receive reimbursement.

Billing & Collection

Billing and Collection service involves confirming a patient’s insurance coverage, active status, and specific benefits before their appointment. By identifying co-pays, deductibles, and required prior authorizations upfront, staff can prevent claim denials and help patients understand their financial responsibilities.

Eligibility Verification

Eligibility verification is the process of verifying a patient’s health insurance coverage and benefits to determine what services are covered and the level of coverage available. This process is essential for healthcare providers to ensure that they receive proper reimbursement for services rendered and that patients are not left with unexpected medical bills.

Revenue Cycle Management

RCM is the financial process that manages the entire lifecycle of a patient’s account, from the initial appointment scheduling to the final balance payment. It integrates eligibility, coding, billing, and collections into a single, cohesive workflow aimed at maximizing a practice's profitability.

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