2025 Big Updates on Medicare Reimbursement and Payment System: Impacts and Compliance

The Medicare Physician Fee Schedule (PFS) is a key component of the Medicare payment system. It sets the rates for services provided by physicians and other healthcare professionals under Medicare Part B. Established by the Centers for Medicare & Medicaid Services (CMS), the PFS is updated annually and outlines how healthcare providers are reimbursed for services, including office visits, surgical procedures and diagnostic tests. Each year, CMS publishes a proposed rule for the next year’s PFS, outlining any changes in reimbursement rates, coding updates and new or revised regulations. Stakeholders, including healthcare providers and advocacy groups, have the opportunity to comment on these proposals before they are finalized. The final rule is typically released in the fall, with changes going into effect on January 1 of the following year.

In recent years, updates to the PFS have focused on shifting towards value-based care, promoting telehealth services and addressing disparities in reimbursement across different types of providers and services. Understanding the Medicare Physician Fee Schedule is essential for healthcare providers, as it directly impacts revenue cycles, practice operations and patient care delivery. The PFS plays an important role in ensuring that physicians and healthcare providers receive fair compensation for the care they provide while helping to control Medicare spending. It impacts millions of healthcare providers and influences how physicians manage their practices, allocate resources and deliver care.

For patients, the PFS can affect the availability and accessibility of services, as providers may adjust their practices based on reimbursement rates. Get ahead of the curve with expert insights on the Centers for Medicare & Medicaid Services (CMS) proposed rule for 2025. In this webinar, we will break down the complex regulations, payment model changes and compliance requirements that could significantly impact healthcare providers, payers and patients.

Learn about the latest regulatory updates, proposed changes to reimbursement models and how these updates are expected to reshape the current healthcare landscape. Gain a clear understanding of the provisions impacting Medicare Part A and Part B services, as well as changes to Medicare Advantage (Part C) and prescription drug plans (Part D). The webinar will cover proposed adjustments to the Medicare PFS, focusing on shifts in Relative Value Units (RVUs), the conversion factor, and how these changes could impact provider reimbursement and practice sustainability. Although the rule is still in the proposal stage, preparing your organization now is critical. We will outline steps you can take to stay proactive, including setting up systems for ongoing monitoring and training to ensure seamless compliance when the final rule is enacted.

Learning Outcomes:

• A deep dive into the CMS Rules for 2025: what it covers, what’s new, and how it will affect the healthcare landscape
• Learn the Latest regulatory updates and changes to reimbursement models and its impact on physicians and practice’s revenue
• Discuss finalized proposals
• Changes in payment structures, including value-based payment models and how they influence provider reimbursement
• Preparing for the administrative and operational shifts that may accompany the new rule
• How the proposed changes aim to improve patient care outcomes and reduce healthcare costs

Areas Covered in the Session:

• CY 2025 PFS Rate Setting and Conversion Factor
• 2025 Premiums, Deductibles, and Coinsurance
  • Medicare Part B
  • Medicare Part A
• Caregiver Training Services (CTS)
• Caregiver Training New Codes – G0541-G0543
• Services Addressing Health-Related Social Needs
• Visit complexity add-on code G2211
  • Annual Wellness Visit (AWV)
  • Vaccine administration
  • Any Medicare Part B preventive service
• Telehealth Services Under the PFS
• Updates to Medicare Part D Drug Coverage
• Advanced Primary Care Management Services (APCM)
• Cardiovascular Risk Assessment and Management
• Opioid Treatment Programs (OTPs)
• Behavioral Health Services
• Infectious Disease Add-On Code
• Hospital Inpatient or Observation Evaluation and Management Add-On for Infectious Diseases
• Strategies for Improving Global Surgery Payment Accuracy
• Therapy – CY 2025 Changes
• CY 2025 Other Major Updates
  • Dental and Oral Health Services
  • Drugs and Biological Products Paid Under Medicare Part B
  • Approach to Payment Limit Calculations when Negative or Zero Average Sales Price (ASP) Data Is Reported to CMS
  • Payment for Radiopharmaceuticals in the Physician Office Setting
  • Immunosuppressive Therapy
  • Blood Clotting Factors
  • Medicare Preventive Services
  • Expanded Colorectal Cancer Screening
• Lowering Drug Costs

Recommended participants:

• Healthcare Administrators
• Physicians
• Practice Owners
• Non-Physician Practitioners
• Medical Office Managers
• Billers and Coders
• Medical Assistants
• Nurses
• Agency Owners
• Clinical Supervisors
• Directors of Nursing
• Quality Improvement/ Quality Assurance Managers
• Compliance Officers
• Clinicians
• Administrative Staff
• Out-of-Network Providers
• C-level Executives
• Office Managers and Staff
• Billing Managers
• Medical Billing Companies
• Insurance Companies
• Hospital Revenue Cycle Staff
• Credentialing Staff
• Medical Providers who are Involved in the Payment Process of their Practice
• Financial Officers and Healthcare Policy Professionals

Presenter Biography: