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 Medicare Physician Fee Schedule (PFS) final rule, published annually in November, will outline new payment policies, rates, and quality-related provisions for physician services in CY 2026.
Every specialty that bills Medicare for services rendered will need to be informed of these changes to be prepared to submit accurate claims in the new year. Often private payers follow Medicare guidelines for coverage decisions and reimbursement rates. All pertinent Medicare payment details that could impact your revenue positively and/or negatively will be explained. Stay informed to guide your practice in a positive direction in 2026.
View details on CMS's final rule under the Curriculum tab.
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Jan Hailey
MHL, CMC, CMCO, CMIS, CMOM, CMCA E/M
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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.
Participants will be informed of updated legislation and Medicare policy changes and be equipped to make informed decisions that protect and benefit the practice in response. This intermediate-level course is designed for medical practice leaders and their staff responsible for managing the business aspects of a healthcare practice. The content will also benefit healthcare consultants, compliance officers, and provider reimbursement teams.
A basic level of knowledge of provider billing and compliance processes is assumed.
This session will explain the major provisions and help you identify both risks and opportunities for your organization under the new rule. After attending this session, participants will be able to:
- Identify the two separate conversion factors and understand how the -2.5 % efficiency adjustment affects payment rates
- Describe major Practice Expense (PE) methodology revisions and their effect on different settings of care
- Comprehend updates to GPCIs, malpractice RVUs, and site-of-service adjustments
- Recognize new and revised G-codes and add-on codes for advanced primary care management and care Coordination services
- Understand the finalized changes to telehealth coverage and the evolving definition of direct supervision using real-time audio/visual communication.
- Summarize CMS's transition away from Public Health Emergency flexibilities for teaching physicians, with attention to rural and exception policies
- Review payment and coding policy changes for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
- Analyze updates affecting skin substitute products, Part B drugs, ASP pricing, and 340B rebate methodologies
- Discuss the compliance implications and financial strategies practices should implement before the new rule takes effect
- Understand changes to the Quality Payment Program and Shared Savings Program
- Gain details about active items on the OIG Work Plan
This program will be available after December 9, 2025.
Self-paced online program includes unlimited review of previously recorded instruction and downloadable digital companion materials for 6 months.
Prod ID: 531