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Medicare & Compliance Changes: Regulatory Update
Essential Updates for Compliance, Billing, & Revenue Cycle Leaders
The Centers for Medicare & Medicaid Services (CMS) released the finalized Calendar Year (CY) 2027 Physician Fee Schedule (PFS) on November 4, 2026. Taking effect on January 1, 2027, this major rule introduces sweeping updates to payment policies, billing rules, and quality-related provisions for physician services furnished under Medicare Part B.
This course provides an up-to-the-minute, post-release analysis of the final regulations. Learn the exact provider reimbursement and compliance reporting requirements your practice must implement immediately to protect its revenue cycle.
You don’t have to navigate the complex CMS rulemaking alone. PMI’s healthcare practice compliance and revenue cycle management experts will share meaningful insights on the operational impact of the finalized rule for 2027. Attend this session to gain direct answers to your complex regulatory questions and receive critical, actionable execution tips.
Key 2027 Financial & Compliance Impacts We Will Cover:
- CMS Retires HCPCS Code G2211: Master the transition of G2211 from a standalone add-on code into two distinct billing modifiers that apply a percentage-based payment bump rather than a flat rate.
- CY 2027 Finalized Conversion Factors: Calculate the bottom-line impact of the finalized payment reductions, including the $32.63 non-APM conversion factor (a 2.31% drop) and the $32.95 qualifying APM factor.
- Two New Advance Care Planning (ACP) Codes: Unpack the finalized implementation, documentation parameters, and billing rules for the two brand-new ACP codes.
- 340B Part D Reporting Grace Period: Navigate the newly finalized mandate for submitting Medicare Part D claims data to the CMS 340B Repository.
- Remote Monitoring Guardrails: Navigate new compliance mandates, including the mandatory initiating visit requirement for RPM/RTM, new established-patient rules, and the delay on the third-party vendor staff ban.
- Same-Day Modifier 25 Reductions: Unpack the finalized policy that implements a strict payment reduction when an office E/M service is billed with modifier 25 alongside a 0-day global procedure.
- Telehealth Flexibilities & Modifiers: Review the finalized regulations aligning with the congressional extension of home-based telehealth flexibilities through December 2027, along with newly created billing modifiers for 2027.
- MIPS Sunset Timeline: Understand the final timeline shifting traditional MIPS to MIPS Value Pathways (MVPs) by the 2031 performance period and the mandatory 'Core Measure' reporting required starting in 2027.
- OIG Work Plan: Highlights of the latest OIG audit and evaluation projects targeting modifier usage and digital health services.
Give your team a head start on strategic planning, financial forecasting, and compliance mapping for 2027.
Full Schedule
There are no programs scheduled at this time
CEUs:
- PMI — 3
Healthcare practices must be prepared. The cumulative effect of the dual conversion factors, budget neutrality adjustments, and specialty-specific modifier penalties will vary, but the overall impact on practice cash flow will be significant.
This course assumes a foundational understanding of the healthcare regulatory environment. Digital companion materials will be provided with helpful resources and links for use beyond the classroom.
Who Should Attend?
- Practice Managers & Administrators: Protect your cash flow by auditing 2027 fee schedules and updating provider productivity models early against the dual-conversion factor framework.
- Medical Billers & Coders: Avoid claim denials by mastering the new modifier transition for complexity and the modifier 25 pay cuts.
- Compliance Officers & Chart Auditors: Pinpoint target risk areas in your E/M and remote monitoring documentation to prevent costly retrospective recoupments.
Live, Interactive Learning and Helpful Resources
Get your questions answered in real time in PMI's live virtual classroom. Registration includes digital companion materials with helpful links to serve as a resource beyond the classroom.
Register today to stay informed, compliant, and ready
Course content assumes basic knowledge of healthcare legislative compliance. A meeting link to the class will be provided by email a few days prior to the event.
About the Presenter
Jan Hailey MHL, CMC, CMCO, CMIS, CMOM, CMCA E/M
Jan Hailey has more than 30 years of experience in healthcare. She is proficient in administration, coding, and billing roles, and teaches medical office professionals around the country how to excel in their careers. Jan has also been instrumental in the development of PMI's Workforce Initiatives program.
Jan's affinity for teaching has helped countless healthcare providers and medical office professionals over the years. During her expansive career, she has served as Director of Quality for Saint Joseph Physician Network located in Mishawaka, IN, and Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. As Care Management Director, Jan led the physician network and comprehensive interdisciplinary team across the health system working closely with providers, management, staff, community, and payers to develop strategies for process improvement, gap closures, and patient experience. She developed a documentation improvement program and a Hierarchical Condition Category (HCC) coding education program to predict future healthcare utilization by accurately reporting patient complexity.
Prior to joining Saint Joseph, Jan was the Director of Quality, Coding, and Compliance for one of the largest health systems in Northern Indiana. She has a Master of Health Leadership and four professional certifications in office management, coding, insurance processing, and compliance. She is a member of WPS Government Health Administrators (Medicare) Provider Outreach and Advisory Group.