2026 CMS Physician’s Fee Schedule Proposed Rule

Description

Key Learning Objectives

By the end of the webinar, attendees will be able to:

• Identify major changes proposed in the 2026 CMS PFS
• Understand the impact on reimbursement, conversion factors, and RVUs
• G2211 utilization, and remote monitoring services
• Prepare actionable strategies for compliance and revenue cycle adaptation

Key Themes in the 2026 Proposed Rule (as of July 2025)

Conversion Factor Pressure Continues

• The conversion factor (CF) is expected to decline again in real terms due to budget neutrality and lack of inflationary updates.
• Despite short-term legislative fixes, structural issues from MACRA and sequestration persist.

Coding & Payment Trends

• G2211 (complexity add-on code) is gaining traction but still underutilized compared to projections.
• Remote Patient Monitoring (RPM) and Principal Illness Navigation (PIN) services are growing, but reimbursement rates are lagging behind utilization.
• Social Determinants of Health (SDOH) codes are being used more frequently, though their long-term viability may depend on future policy direction.

Practice Expense & Technology Misalignment

• CMS acknowledges that the current practice expense methodology doesn’t account for digital tools like AI, software, or algorithms.
• No formal policy fix yet, but this could affect how tech-enabled services are reimbursed.

MIPS & Quality Payment Program (QPP)

• MIPS Value Pathways (MVPs) are being positioned as the future of QPP.
• CMS is reportedly scaling back equity-focused quality measures, signaling a shift in policy priorities.

Strategic Takeaways for Healthcare Professionals

• Prepare for continued reimbursement compression unless Congress intervenes.
• Monitor G2211, RPM, and PIN utilization trends to align with CMS priorities.
• Reassess denial management and appeals strategies in light of shifting documentation and coding expectations.
• Stay engaged during the comment period to advocate for sustainable payment reform.

Target Audience

• Primary: Healthcare administrators, medical coders, compliance officers, physicians, billing professionals
• Secondary: Policy analysts, consultants, healthcare attorneys