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Medicare & Compliance Changes: Regulatory Update
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. Healthcare practices must be prepared. The cumulative effect of the
finalized 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.
Continuing Education Units (CEUs)
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Earn 3 PMI CEUs for attendance at this program.
Practice Management Institute grants CEUs
for its certified professionals based on
the total number of instructional hours,
with one CEU granted per hour of classroom
instruction. CEUs may be applied to annual
recertification requirements, as directed
in the certification renewal requirements
for your credential or credentials.
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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