Medicare & Compliance Changes 2025

Medicare and Compliance Changes

Advanced knowledge of the latest healthcare compliance and Medicare changes will prepare you to forecast the impact on your practice and respond proactively. The Centers for Medicare & Medicaid Services (CMS) released its Medicare Physician Fee Schedule (PFS) rule for 2025 on November 1. Every specialty that bills Medicare for services rendered will need to be informed about these changes to be prepared to submit accurate claims in 2025. This session will cover the conversion factor and other payment related details that could impact your revenue, share the latest details on the Quality Payment Program (QPP), plus review the recently added and active items on the OIG Work Plan.

Key provisions that have been finalized:

• 2.83% decrease to the conversion factor
• Additions to the Medicare Telehealth Services List
• Expanded definition of interactive telecommunications system
• New G-codes for Advanced Primary Care Management Services for beneficiaries with chronic conditions
• Expanded usability of add-on code G2211
• Coding and payment for an ASCVD risk assessment service and risk management services
• G-code for safety planning interventions by Behavioral Health billing practitioners
• Medicare payment for digital mental health treatment devices
• Expanded coverage for Hepatitis B vaccines and colorectal cancer screening
• Cap on out-of-pocket drug costs and new payment options for beneficiaries
• Broadened applicability of the transfer of care modifier for global packages
• Relaxed direct supervision requirements for certain providers/services
• 6 new MIPS Value Pathways (MVPs)
• Consolidation of 2 neurology-focused MVPs into a single neurological MVP
• Expanded definition of primary care services under MSSP

Course Summary

Attend this program to gain the facts about the payment policies, rates, and quality-related provisions for physician services furnished under the Medicare Part B Physician Fee Schedule (PFS) final rule. Learn which proposals have been finalized and adopted by CMS. Statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 PHE will retake effect for most telehealth services in 2025. The CY 2025 final rule reflects CMS’ goal to preserve some flexibility to expand the scope of and access to telehealth services. Learn the details that will 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.