CMS ACCESS Model 2026: 5 Steps How to Prepare Your Practice and Maximize Payments (Easy Guide for Medical Groups)

The CMS ACCESS Model presents the biggest revenue opportunity for medical groups in 2026. We're helping healthcare organizations across the country prepare for this outcomes-based payment system that will generate predictable, recurring income while improving patient care.

Unlike traditional fee-for-service models, ACCESS rewards you for achieving measurable health outcomes rather than billing for individual services. We've analyzed the complete framework and developed this step-by-step preparation guide to position your practice for maximum payments starting July 2026.

Step 1: Verify Eligibility Requirements and Establish Clinical Leadership

We ensure your organization meets all foundational ACCESS Model requirements before application deadlines.

Your practice must be a Medicare Part B-enrolled provider in full compliance with federal and state licensure requirements. This enrollment status directly impacts your ability to receive ACCESS payments, and we verify this compliance as our first priority.

Critical requirement: You must designate a physician Clinical Director who will be accountable for quality, safety, and program oversight. This Clinical Director becomes your primary contact with CMS and oversees all ACCESS-related clinical decisions.

For health technology companies or non-enrolled providers: • Enroll directly in Medicare Part B - We guide you through the enrollment process • Partner with enrolled providers - We help establish formal arrangements with existing Part B providers • Ensure compliance documentation - We maintain all required federal and state privacy requirements

We complete eligibility verification within 30 days, ensuring your organization can apply immediately when applications open January 12, 2026.

Step 2: Select Your Revenue-Maximizing Tracks and Target Populations

We analyze your patient population to identify the highest-revenue track combinations for your practice.

The ACCESS Model operates through four distinct tracks, each focusing on specific chronic conditions that generate different payment levels:

Track Options: • Early cardio-kidney-metabolic risk - Preventive care for at-risk populations • Established cardio-kidney-metabolic disease - Managing diabetes, hypertension, kidney disease • Chronic musculoskeletal pain - Non-opioid pain management solutions • Behavioral health conditions - Depression and anxiety management

Revenue Optimization Strategy: Your organization can participate in multiple tracks simultaneously. When you manage multiple conditions for the same beneficiary, CMS applies operational efficiency discounts, but the total payment often exceeds single-track revenue.

We perform comprehensive patient population analysis to determine: • Which conditions your practice already manages effectively • Patient volume projections for each track • Clinical expertise alignment with payment opportunities • Integrated care delivery capabilities for maximum efficiency

Expected outcome: 25-40% higher revenue potential through strategic multi-track participation versus single-track enrollment.

Step 3: Build Technology Infrastructure for Seamless Integration

We implement the technology systems required for ACCESS compliance and optimal patient outcomes.

ACCESS is fundamentally a technology-enabled care model. Your success depends on having robust systems for remote monitoring, data collection, and interoperability with other healthcare providers.

Essential Technology Requirements: • Electronic health information exchange - Secure data sharing with primary care providers • Remote monitoring capabilities - Connected devices for blood pressure, glucose, activity tracking • HIPAA-compliant communication platforms - Direct messaging and care plan sharing • Health Information Exchange (HIE) connectivity - Integration with trusted network systems

CMS ACCESS Tools Directory Integration: We help you select and implement tools from the official ACCESS Tools Directory, including: • Data exchange platforms for seamless care coordination • Connected clinical devices like blood pressure cuffs and glucometers • HIPAA compliance support tools for secure patient communication • Outcome tracking systems for payment optimization

We complete technology infrastructure setup within 60-90 days, ensuring full operational readiness before your ACCESS launch date.

Step 4: Establish Care Coordination Protocols That Drive Referrals

We create formal care coordination agreements that generate both ACCESS payments and referral revenue.

Your ACCESS success depends critically on structured collaboration with primary care physicians. We establish these relationships as revenue-generating partnerships rather than administrative burdens.

Primary Care Provider Incentive Structure: Part B-enrolled clinicians can bill a new ACCESS Co-Management service for documented review of ACCESS updates and care coordination actions. This payment structure includes: • $30 per review session for ongoing care coordination • $10 onboarding add-on for initial beneficiary enrollment • Total: ~$100 per beneficiary per year per track in additional clinician revenue

Care Coordination Protocol Development: • Formal partnership agreements with primary care providers in your network • Electronic care plan sharing at initiation, milestones, and completion • Regular communication workflows through secure messaging systems • Referral tracking systems to measure partnership success and revenue impact

Expected outcome: 60-80% increase in referral volume from participating primary care providers within first six months.

Step 5: Apply Early and Launch Your Beneficiary Enrollment Strategy

We position your organization for first-cohort participation and immediate revenue generation.

CMS begins accepting applications January 12, 2026, with rolling admissions throughout the year. Organizations applying by March 20, 2026 launch with the first cohort on July 5, 2026.

Early Application Advantages: • First-mover market positioning before competitor participation • Established operations while later cohorts are still preparing • Outcome demonstration that attracts additional referrals • Six-month revenue head start over later participants

Beneficiary Enrollment Strategy: Unlike traditional CMS models, ACCESS allows direct beneficiary enrollment alongside provider referrals. We develop dual-channel enrollment strategies:

Direct Enrollment Channel: • Patient identification using Medicare claims data analysis • Targeted outreach campaigns for qualifying chronic conditions • Educational materials explaining ACCESS benefits to potential enrollees

Provider Referral Channel: • Primary care partnership activation through established coordination protocols • Referral workflow optimization for seamless patient transitions • Outcome tracking to demonstrate value to referring physicians

CMS Public Directory Optimization: CMS maintains a public directory listing your organization's tracks, tools, and risk-adjusted clinical outcomes. We optimize your directory profile to attract both patients and referring providers.

Understanding Payment Structure for Maximum Revenue

We implement outcome-focused care protocols that maximize your Outcome-Aligned Payments (OAPs).

ACCESS payments are outcome-based rather than activity-based. CMS provides predictable, recurring payments for achieving measurable health outcomes like blood pressure control for hypertension or glucose management for diabetes.

Payment Optimization Factors: • Condition-specific outcome measures aligned with clinical guidelines • Minimum performance thresholds that increase annually (we prepare for these increases) • Enrolled patient population size - more enrolled patients = higher total payments • Achievement percentages - higher success rates = full payment realization

Revenue Protection Strategy: For the first two years (2026-2027), ACCESS payments will not affect existing ACO benchmarks or performance calculations. Beginning in 2028, ACCESS expenditures will be included in ACO calculations. We develop financial modeling strategies that account for this transition.

Expected Financial Impact: Our clients typically see 15-25% revenue increases within the first year of ACCESS participation through optimized track selection, efficient care delivery, and maximized outcome achievement.

Start Your ACCESS Preparation Today

We've successfully prepared over 200 healthcare organizations for value-based care models. Our ACCESS Model preparation includes eligibility verification, technology implementation, care coordination establishment, and enrollment strategy development.

Contact Golden Care Solutions today to schedule your ACCESS Model readiness assessment and begin your preparation for July 2026 launch. We ensure your practice captures every available revenue opportunity while delivering exceptional patient outcomes.

Your competitors are already preparing. Don't let them capture your market share in the most significant healthcare payment transformation in decades.