Academy
How these programmes actually work.
Who qualifies, what the month has to show, what the codes pay, and where the rules are still open. Written for the person who has to run it.
Medicare rules as they stand in October 2026. Figures are CY2026.
Four ways in
Depending on what you came to work out.
- Start hereWhich programme is my patient?The single most confusing thing about this category is which of the four a given patient belongs in. Describe the patient and the filter narrows it.Read it
- The arithmeticWhat is the gap actually worth?How many of your Medicare patients qualify, how few are enrolled nationally, and what the code pays. Third-party figures, cited, with the dials on your own panel.Read it
- For a single practiceRunning this without hiring anyoneWhat the month looks like, what your team still does, and why the constraint is hours rather than billing knowledge.Read it
- For a groupRolling it out across sitesThe same programmes and the same codes, configured once and run clinic by clinic. Including the facility-schedule caveat that catches system readers out.Read it
One page each
The four programmes, in full.
Each page sets out who is eligible, what the month has to show, what your team still does, what the code pays, and the source behind each rule.
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Ready when you are
Read enough? Hear it make the call.
Bring your panel numbers. We will go through which programmes your patients already qualify for, and what your team would still do.
- Your patients, your claim
- Your team reviews and attests
- Nothing bills until a person approves