The Centers for Medicare and Medicaid Services (CMS) proposes a significant shift in how Medicare reimburses doctors, moving away from the traditional method of calculating rates based on survey data from the Relative Value Scale Update Committee (RUC). This change, outlined in the 2026 Medicare Physician Fee Schedule, aims to reduce payments for many specialist services—such as surgery and diagnostic imaging—by an estimated 2.5%, while prioritising investment in primary care. The American Medical Association (AMA) and other physician groups strongly oppose this, arguing it could compromise patient safety and quality by encouraging increased service volume to offset lost revenue. CMS, however, characterises this as an "efficiency adjustment" for services that have become more streamlined over time, with the overarching goal of better aligning payment with modern clinical practice and supporting value-based care, although some medical societies cautiously endorse the agency's focus on primary care. this podcast discuss this in short for american based audience

Tune in for a crucial breakdown of the latest proposed changes impacting Medicare payments for doctors, new healthcare models, and telehealth services. This episode dives deep into the draft regulation released by the Centers for Medicare and Medicaid Services (CMS), outlining significant updates that could reshape healthcare delivery and access.Here's what you'll learn:• Physician Pay Hike: Discover how doctors are set for a 2.5% increase in the base Medicare rate in 2026, a mandate from the recent "One Big Beautiful Bill". We'll also explain the higher reimbursement boost for doctors participating in alternative payment models, with a conversion factor of 3.83% compared to 3.62% for traditional fee-for-service Medicare. This follows a challenging year for doctors, who saw a 2.9% reduction in Medicare reimbursement.• New Mandatory Payment Models: Unpack the proposed five-year Ambulatory Specialty Model, which would mandate specialists to improve care for heart failure and lower back pain starting in 2027. Learn about this two-sided risk model and how CMS aims to assess quality, costs, and early intervention.• Enhanced Telehealth Flexibilities: Understand how CMS proposes to simplify the process for making additional telehealth services reimbursable under Medicare. Plus, explore new rules allowing physicians to carry out direct supervision for certain services, like cardiac rehabilitation, using audiovisual telecommunications.• Changes to the Shared Savings Program: We'll cover proposed limits on how long certain Medicare Shared Savings Program participants can remain in one-sided risk arrangements, with the goal of increasing participation in two-sided risk arrangements. Accountable Care Organisations (ACOs) are also set to gain some relief from the requirement to cover at least 5,000 Medicare beneficiaries, with a new three-year window to achieve this benchmark from 2027.• CMS's Vision: Hear directly from CMS Administrator Dr. Mehmet Oz on the agency's goals: "We’re making it easier for seniors to access preventive services, incentivising healthcare providers to deliver real results and cracking down on abuse that drives up costs".This insightful discussion highlights CMS's ongoing efforts to tackle chronic illness and prevention, and its deregulation agenda, with a crucial deadline for public comments set for 12 September. Stay informed on these vital changes affecting healthcare providers and beneficiaries across the nation.

A proposed $1 billion Medicare cut for 2026 is sending shockwaves through the home healthcare industry. Could a 6.4% rate reduction spell disaster for patient access and rural care – or will it spark innovation and consolidation?

In this episode, we dive into the potential impact on providers, patients, and the overall healthcare system. From the closure of 900 home health agencies since 2020 to concerns about "care deserts" in rural America, industry leaders are sounding the alarm. Yet some analysts argue this could drive efficiency and tech-driven transformation.

Tune in as we unpack both sides of the debate and explore what's really at stake for the future of post-acute care in the U.S.

Keywords:
Medicare Cuts, Home Health, CMS Proposal, Healthcare Policy, Patient Access, Rural Health, Industry Consolidation, Post-Acute Care, 2026 Healthcare Changes

Welcome to @Xpertrcmtalk RCM Talk! In this episode, we dive deep into the game-changing world of prior authorization streamlining for 2025. Discover how leading health insurers like UnitedHealthcare, Aetna, Cigna, and Blue Cross Blue Shield are revolutionizing the healthcare industry by slashing delays, reducing paperwork, and transforming patient care.We break down exactly what prior authorization streamlining means for healthcare providers, medical billing teams, and patients. Learn about new reforms, real-time approvals, and how these changes will impact your medical practice’s revenue cycle management. Our expert insights will help you navigate the transition, avoid common pitfalls, and maximize the benefits of these historic reforms.Key Topics Covered:Prior authorization streamliningHealthcare administrative reformsMedical billing and revenue cycle managementReal-time insurance approvalsReducing healthcare delaysTips for providers and billing teamsDon’t miss out on the latest updates in healthcare administration! Subscribe to Xpert RCM Talk for more expert discussions on revenue cycle management, denial management, medical coding, and all things medical billing.#billingcompliance #PriorAuthorizationStreamlining #HealthcareReform #MedicalBilling #medicalcoding #XpertRCMTalk #priorauthorization #usa

Telehealth Patients & Providers: Major Medicare Rule Changes Are Here

Booked a virtual doctor’s appointment? You might already be breaking Medicare’s new rules without even knowing it. Starting April 2025, Medicare is rolling back key telehealth flexibilities from the pandemic era — and it’s about to cause a major shift for doctors and patients alike.

From billing complexities and location restrictions to what services can still be done virtually, this video explains everything you need to know — clearly and concisely.

In this video, we cover:

• How telehealth surged from 0.13% to 2% of Medicare visits

• Why preventive care led the way in virtual adoption

• The impact of new Medicare billing rules on providers

• What mental health services remain covered via telehealth

• What doctors need to know to avoid denied claims

• How patients can still access virtual care and protect their options

Whether you're a patient trying to avoid crowded waiting rooms, or a provider trying to keep up with billing rules, this video will help you navigate the changes before April 2025 arrives.

Plus: Learn how Human Medical Billing supports practices in staying compliant, getting paid faster, and focusing on what matters — patient care.

www.humanmedicalbilling.com

Subscribe, stay informed, and share this video with others in the healthcare space.

#Telehealth #Medicare2025 #MedicalBilling #HealthcareNews #VirtualCare #MedicareChanges #HealthcarePolicy #MentalHealth #HumanMedicalBilling #PracticeManagement #BillingCompliance #CARESAct #MedicareBilling #HealthTech