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 CMS's proposed changes 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 course will clarify which proposals have been finalized and adopted by CMS for implementation in 2026 and beyond. Provisions covered in the proposed PFS 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
Self-paced online program includes unlimited review of previously recorded instruction and downloadable digital companion materials for 6 months.
Prod ID: 531