Medicare & 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, which will be released in November.
Every specialty that bills Medicare for services rendered will need to be
informed about these changes to submit accurate claims in the new year, and
other payers typically follow suit. Pertinent details that impact your revenue
positively and/or negatively will be explained. 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 providesupervision 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 HealthClinics (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
The latest details on the
Quality Payment Program (QPP) and recently added active items on the OIG Work
Plan will also be reviewed. Learn what you need to know about the changes to
help you best determine what course of action your practice should take in
response. Make informed decisions to guide your practice is a positive
direction in the new year.
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.
Register today to stay
informed, compliant, and ready
Registration includes digital
companion materials to serve as a resource beyond the classroom.
Continuing Education Units (CEUs)
Earn 3 PMI CEUs for attendance at this program. Practice Management Institute grants CEUs for its certified professionals based on total number of instructional hours (1 CEU per hour of classroom instruction). CEUs may be applied to annual recertification requirements, as directed in the certification renewal requirements for your credential(s).
If you are seeking CEU credits for other certifications or organizations, please contact your organization for pre-approval and credit guidelines. A certificate of attendance will be provided.
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