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Medicare and Compliance Changes


Be Prepared for January 1

Advance knowledge of the latest healthcare compliance and Medicare updates will prepare you to forecast the impact on your practice and respond proactively. The proposed* Medicare Physician Fee Schedule (PFS) rule indicates that major changes are forthcoming in 2026. Join PMI's annual update program to gain clarity on the new payment policies, rates, and quality-related provisions for physician services furnished under the 2026 PFS final rule. Every specialty that bills Medicare for services rendered will need to be informed about these changes to be prepared to submit accurate claims in the new year. Attend this session to learn the facts of which proposals will be finalized and adopted by CMS for implementation in 2026 and beyond. All pertinent Medicare payment details that could impact your revenue positively and/or negatively will be explained.

Provisions covered in the rule include:

  • Two separate conversion factors and an efficiency adjustment (-2.5%)
  • Significant updates to Practice Expense methodology
  • Updates to the geographic practice cost indices (GPCIs) and malpractice RVUs
  • New G codes and add on codes for Advanced Primary Care Management
  • Streamlined process for adding services to the Medicare Telehealth Services List
  • CMS is seeking to remove the distinction between provisional and permanent services and will limit review on whether the service can be furnished using an interactive, two-way audio-video telecommunications system
  • Expanded policies for DMHT services / devices used in the treatment of ADHD
  • Definition of direct supervision to allow supervising practitioners to provide supervision through real-time audio and visual interactive telecommunications
  • Transitioning back to pre-PHE policy for teaching physician reimbursement requirements with a rural exception
  • Changes to the way CMS pays for skin substitute products under the PFS
  • Coding and payment policy changes for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
  • Policies for the Medicare Prescription Drug Inflation Rebate Program to include establishing a claims-based methodology to remove 340B units from Part D rebate calculations
  • Guidance regarding Part B drugs and biologicals ASP pricing concessions and bona fide service fees

* CMS is expected to release the final rule in November.

Full Schedule


There are no programs scheduled at this time


CEUs:

PMI 3
AAPC 3

Target Audience

This intermediate-level course is designed for medical practice leaders and their staff responsible for managing the business aspects of a healthcare practice. A basic level of knowledge of provider billing and compliance processes is assumed. The content will also benefit healthcare consultants, compliance officers, and provider reimbursement teams.

Why Attend this Session?

Learn what you need to know about updated legislation and policy changes to help you best determine what course of action your practice should take in response. Often private payers follow Medicare guidelines for coverage decisions and reimbursement rates. Make informed decisions to guide your practice is a positive direction in the new year.

Live, Interactive Learning and Helpful Resources

Get your questions answered in real time in PMI's live virtual classroom. Registration includes digital companion materials to serve as a resource beyond the classroom.

Register today to stay informed, compliant, and ready

Registration includes live instructor led classroom instruction plus companion digital materials. A meeting link will be provided by email a few days prior to the event.