Podcasts about medicare physician fee schedule

Can Therapists Start a Union? The Antitrust Trap, the Shadow Committee, and the Economic Strangulation of American Psychotherapy Analyzing America's Healthcare Regulations and Their Effect on Us: Why the Law Prevents Therapists from Organizing While Allowing a Private Committee to Fix Prices for the Entire Medical System https://gettherapybirmingham.com/can-therapists-start-a-union-spoiler-alert-they-cant/ The Monthly Rage Thread If you hang around therapist forums long enough, you will see it happen. It operates with the regularity of the tides. Someone posts a thread, usually after receiving a contract from an insurance company offering 1998 rates for 2025 work, and asks the obvious question: “We are the ones providing the care. The system collapses without us. Why don't we just all go on strike? Why don't we form a union and demand fair pay?” It is a logical question. In almost every other sector of the economy, workers who feel exploited band together to negotiate better terms. Screenwriters shut down Hollywood to get paid for streaming residuals. Auto workers walk off the line. Teachers fill the state capitol. Nurses at major hospital systems have successfully unionized and won significant concessions. So why, in the midst of a national mental health crisis, does the mental health workforce remain so politically impotent? The answer is not that we lack will. It is not that we lack organization. The answer is that for private practice therapists, forming a union is a federal crime. This is not a political manifesto. It is an analysis of the bizarre regulatory environment that governs American healthcare, a system of antitrust laws, shadow committees, and bureaucratic classifications that effectively strips clinicians of their bargaining power while empowering the corporations that pay them. If you want to understand why corporate tech monopolies are ruining therapy, or why the corporatization of healthcare feels so suffocating, you have to understand the legal straitjacket we are all wearing. And you have to understand the one group that is allowed to set prices, the one group exempt from the rules that bind the rest of us. Part I: You Are Not a Worker, You Are a Standard Oil Tycoon The primary reason therapists cannot unionize dates back to the era of oil barons and railroad tycoons. The Sherman Antitrust Act of 1890 was designed to prevent massive corporations like Standard Oil from colluding to fix prices and destroy the free market. It prohibits “every contract, combination… or conspiracy, in restraint of trade.” The law was a response to genuine abuses: companies buying up competitors, dividing territories, and coordinating prices to gouge consumers who had no alternatives. Here is the catch: In the eyes of the federal government, a private practice therapist is not a “worker.” You are a business entity. Even if you are a solo practitioner struggling to pay rent in a subleased office, seeing clients between crying in your car and eating lunch at your desk, the law views you as the CEO of a micro-corporation. You are classified as a 1099 independent contractor, not a W-2 employee, and that distinction makes all the difference in the world. If two workers at Starbucks talk about their wages and agree to ask for a raise, that is “collective bargaining,” which is protected by the National Labor Relations Act. But if two private practice therapists talk about their reimbursement rates and agree to ask Blue Cross for a raise, that is “price-fixing.” It is legally indistinguishable, in the eyes of the Federal Trade Commission, from gas stations conspiring to raise the price of unleaded. It sounds absurd, but the FTC takes it deadly seriously. When independent contractors organize to demand higher rates, when they share information about what they are being paid and coordinate their responses, they are engaging in horizontal price-fixing, one of the most serious violations of antitrust law. The Sherman Act provides for criminal penalties, including fines and imprisonment. The law that was meant to break up monopolies is now used to prevent social workers from asking for a cost-of-living adjustment. The irony is crushing. The same regulatory framework that prevents two therapists from discussing their rates allows massive insurance conglomerates to merge repeatedly, concentrating buyer power in fewer and fewer hands. UnitedHealth Group, for example, has acquired dozens of companies over the past two decades, becoming the largest healthcare company in the United States. When they offer a “take it or leave it” contract to providers, they do so with the full knowledge that fragmented, legally prohibited from organizing therapists have no counter-leverage. The antitrust laws, designed to prevent monopoly power, have created a system where sellers are atomized and buyers are consolidated. Economists call this “monopsony,” and it is precisely the market distortion the Sherman Act was supposed to prevent. Part II: The Day the “Learned Profession” Died For a long time, doctors and lawyers thought they were exempt from these laws. They argued that they were “learned professions,” not mere tradespeople, and therefore above the grubby laws of commerce. They believed that their ethical obligations to patients and clients set them apart from the rules that governed steel mills and meatpacking plants. Medicine was a calling, not a business, and surely the government would not regulate the sacred doctor-patient relationship as if it were a commercial transaction. That illusion was shattered in 1975 by the Supreme Court case Goldfarb v. Virginia State Bar. The case involved lawyers, not doctors, but its implications cascaded through every licensed profession in America. The Goldfarbs were purchasing a home and needed a title examination. The Virginia State Bar had established a minimum fee schedule for such services, and every lawyer they contacted quoted the exact same price. They sued, arguing that this fee schedule was illegal price-fixing. The Supreme Court agreed. In a unanimous decision, the Court ruled that professional services, including legal and medical advice, are “trade or commerce” subject to antitrust laws. The “learned profession” exemption, which had been assumed but never explicitly established in law, was declared a myth. “The nature of an occupation, standing alone,” the Court wrote, “does not provide sanctuary from the Sherman Act.” This ruling was intended to lower prices for consumers by preventing lawyers from setting minimum fees, and in that narrow sense it was a good thing. But in healthcare, it had a catastrophic side effect: it made it illegal for doctors and therapists to band together to resist the pricing power of insurance companies. The “learned profession” exemption is dead. We are now just businesses, and businesses are not allowed to hold hands. This creates the illusion of progress: we have “free market” competition among providers, but monopsony power among payers. It is a market where the sellers are forbidden from organizing, but the buyers are allowed to merge until they are too big to fail. The result is not a free market at all. It is a market designed to transfer wealth from one class (providers) to another (insurers and administrators), with the law itself serving as the enforcement mechanism. Part III: The Cartel in the Basement If therapists cannot collude to set prices, surely nobody else can, right? Wrong. There is one group in American healthcare that is allowed to meet in a room, decide what every doctor's time is worth, and set prices for the entire industry. It is called the RUC, the AMA/Specialty Society Relative Value Scale Update Committee. And understanding the RUC is the key to understanding why talk therapy is dying in the medical model, why psychiatrists abandoned the couch for the prescription pad, and why your insurance company offers you a ghost network of providers who never answer the phone. The Birth of a Shadow Government To comprehend the current crisis in mental health economics, one must excavate the foundations of the physician payment system. Prior to 1992, Medicare reimbursed physicians based on a system known as “Customary, Prevailing, and Reasonable” charges. Under this system, physicians were paid based on their historical billing charges. It was inherently inflationary; it rewarded those who raised their fees most aggressively and created wide geographic disparities for identical services. In response to spiraling costs, Congress passed the Omnibus Budget Reconciliation Act of 1989, mandating a transition to a fee schedule based on the resources required to provide a service. This birthed the Resource-Based Relative Value Scale. The intellectual architecture for this system was developed by a team of economists at Harvard University, led by William Hsiao. Hsiao's team sought to create a “unified theory” of medical value, attempting to quantify the “work” involved in disparate medical acts, comparing the cognitive intensity of a psychiatric evaluation with the technical skill of a hernia repair. The Harvard study was revolutionary. It promised to level the playing field, suggesting that cognitive services, the thinking and talking that comprises primary care and mental health, were vastly undervalued relative to surgical procedures. Had Hsiao's original recommendations been implemented purely, the income gap between generalists and specialists might have narrowed significantly. But the administrative complexity of assigning values to over 7,000 Current Procedural Terminology codes overwhelmed the Health Care Financing Administration. Into this administrative vacuum stepped the American Medical Association. The AMA, fearing that the government would unilaterally set prices, proposed a “partnership.” They would convene a committee of experts to maintain and update the relative values, providing this labor-intensive service to the government at no cost. The government accepted. Thus, in 1991, the RUC was born, not as a government agency, but as a private advisory body with unparalleled influence over public funds. The Architecture of Control The RUC's claim to legitimacy rests on its status as an “expert panel.” But a structural analysis of its composition reveals a profound bias that mimics the governance of a cartel designed to protect incumbent interests. The committee consists of 32 members, but power is concentrated in the 29 voting seats. Of these, 21 seats are appointed by major national medical specialty societies. The distribution is not proportional to the volume of services provided to Medicare beneficiaries, nor is it proportional to the physician workforce. Instead, it is frozen in a historical moment that favored high-technology specialties. Primary care physicians, who perform roughly 45 to 50 percent of Medicare work, hold approximately 4 to 5 seats, giving them about 17 percent of the vote. Procedural and surgical specialties, including surgery, radiology, and anesthesiology, hold 15 to 18 seats, giving them roughly 60 percent of the vote despite performing only 35 to 40 percent of Medicare work. The American Psychiatric Association holds a single seat. One seat. This lone representative must negotiate with a supermajority of specialists, neurosurgeons, cardiothoracic surgeons, radiologists, and ophthalmologists, whose financial interests are often diametrically opposed to the valuation of cognitive work. The cartel dynamic is enforced by a statutory requirement of budget neutrality. The Medicare Physician Fee Schedule is a zero-sum game. If the total relative value units projected for a given year exceed the budget, a “scaler” is applied to reduce the conversion factor, effectively cutting everyone's pay. Therefore, any proposal to increase the value of psychotherapy, which would increase the total RVU spend, effectively asks every surgeon in the room to take a pay cut to fund the raise for psychiatrists. Given that a two-thirds majority is required to pass a recommendation, the procedural bloc holds absolute veto power over any redistribution of wealth. The Secret Chamber A hallmark of cartel behavior is the restriction of information. For nearly two decades, the RUC operated in near-total secrecy. While recent years have seen minor concessions to transparency, such as the publication of vote totals, the core deliberative process remains opaque. RUC meetings are private. The public, the press, and even non-RUC physicians are largely barred from attending the deliberations where billions of tax dollars are allocated. Participants, including the specialty advisors who present data, must sign strict non-disclosure agreements. These agreements prevent them from discussing the specific tradeoffs, deals, or arguments made within the chamber. A former RUC participant described these agreements as “draconian,” designed to insulate the committee from public accountability. The Government Accountability Office and the Center for American Progress have noted the inherent conflict of interest. The individuals setting the prices are the same individuals who receive the payments. Unlike a regulatory agency, where officials are salaried and divested of industry assets, RUC members are practicing physicians whose personal incomes are directly tied to the decisions they make. This secrecy serves a functional purpose: it allows for “logrolling.” A representative from Orthopedics might support an inflated value for a Cardiology code in exchange for Cardiology's support on a Knee Replacement code. This “I'll scratch your back” dynamic creates an upward pressure on procedural values that excludes those outside the dominant coalition, specifically primary care and mental health. The Antitrust Shield Why has the Department of Justice not broken up this cartel? The legal shield is the Noerr-Pennington Doctrine. This Supreme Court doctrine establishes that private entities are immune from antitrust liability when they are petitioning the government. Because the RUC technically only “recommends” values to CMS (that is petitioning), and CMS “decides” (that is government action), the RUC is protected by the First Amendment right to petition. This legal loophole allows the RUC to operate with monopolistic characteristics without fear of prosecution, provided CMS continues to go through the motions of “reviewing” the recommendations. And CMS accepts those recommendations over 90 percent of the time. Because private insurance companies generally base their rates on Medicare, this private committee effectively sets the price of healthcare for the entire country. If independent therapists did this, if they gathered in a room and agreed on what their services should cost, they would face criminal prosecution. But because the RUC operates under the fiction of “advising” the government, it is protected. The same regulatory framework that criminalizes therapist solidarity provides cover for industry-wide price coordination by the most powerful medical specialties. Part IV: The Mechanics of Suppression To control a market, one must control its currency. In American medicine, that currency is the Relative Value Unit. Every medical service, from a 15-minute therapy session to a heart transplant, is assigned a total RVU value. This value is the sum of three components: the Work RVU, which accounts for physician time, technical skill, mental effort, and judgment; the Practice Expense RVU, which covers overhead costs like rent, staff, and equipment; and the Malpractice RVU, which reflects professional liability insurance costs. The Work RVU, which comprises roughly 50 to 55 percent of the total value, is determined by RUC surveys. When a code is flagged for review, the relevant specialty society distributes a survey to a sample of its members. These respondents are asked to estimate the time and intensity of the service compared to a “reference service.” This methodology violates several principles of statistical validity. The surveys are voluntary and distributed by the specialty societies themselves. The respondents are typically those most active in the society and most invested in maximizing reimbursement, advocates rather than neutral observers. The sample sizes are often shockingly small; RUC surveys frequently rely on fewer than 50 or 70 respondents to set the price for services performed millions of times annually. A sample of 30 orthopedic surgeons might determine the value of a procedure costing Medicare billions. The Time Arbitrage The most critical variable in the RUC equation is time. The Work RVU is conceptually derived from the formula: Work equals Time multiplied by Intensity. Therefore, inflating the time estimate is the most direct route to inflating the price. Independent studies by RAND and the Urban Institute, often using objective data like Operating Room logs, have consistently shown that the RUC overestimates the time required for surgical procedures. A procedure valued by the RUC as taking 60 minutes may, in reality, take 30 minutes. This creates an arbitrage opportunity. If a gastroenterologist can perform a “60-minute” colonoscopy in 20 minutes, they can effectively perform three procedures in the time allotted for one. They bill for three hours of work in one hour of real time. This “efficiency gain” is captured entirely by the physician as profit. Psychotherapy cannot utilize this arbitrage. CPT codes for psychotherapy are explicitly time-based in their definition. Code 90832 requires 16 to 37 minutes. Code 90834 requires 38 to 52 minutes. Code 90837 requires 53 minutes or more. A psychiatrist cannot perform a 60-minute therapy session in 20 minutes; doing so constitutes fraud. Therefore, the revenue of a psychotherapist is capped by the linear passage of time. They can sell, at maximum, roughly 8 to 10 units of labor per day. A proceduralist, aided by RUC-inflated time assumptions, can sell 20 or 30 units of “RUC time” in the same day. This structural discrepancy creates a widening income gap that no amount of “hard work” by the therapist can close. It is not a market failure. It is market design. The “Thinking” Penalty The RUC's bias is not merely structural; it is philosophical. The committee, dominated by surgeons and proceduralists, consistently values “doing things to people,” cutting, scanning, injecting, far more highly than “talking to people,” diagnosing, counseling, managing complex chronic conditions. This creates a regulatory environment that functions as a de facto wealth transfer from cognitive care to procedural care. In 2013, a major revision of psychiatry codes exposed this bias in stark relief. Previously, psychiatrists used codes that bundled the medical evaluation with the psychotherapy. The new system required psychiatrists to bill an E/M code for the medical management plus an “add-on” code for psychotherapy. While intended to improve transparency, this change exposed psychotherapy to the raw mechanics of the RUC's valuation bias. By isolating the “therapy” component, the committee could subject it to rigorous cross-specialty comparison. And the committee, dominated by surgeons, views “talking to a patient” as low-intensity work compared to “operating on a patient.” The economic signal was clear. This created the 15-minute med check culture not because psychiatrists stopped caring, but because the regulatory environment made relational care financial suicide. It effectively “illegalized” the practice of deep, slow psychiatry for anyone who wanted to take insurance. Part V: The “Messenger Model” and Other Legal Fictions When therapists ask about collective bargaining, lawyers will often point them to the only legal loophole available: the “Messenger Model.” In this model, a third party (the messenger) acts as an intermediary between a group of providers and an insurance company. The messenger takes the insurance company's offer and conveys it to each therapist individually. Each therapist must then make a unilateral, independent decision to accept or reject it. The messenger is strictly forbidden from negotiating. They cannot say, “The group rejects this.” They cannot say, “We want 10% more.” They cannot advise the therapists on what to do. They can only carry messages. This is why “Independent Practice Associations” are often toothless. In the 2008 case North Texas Specialty Physicians v. FTC, the Fifth Circuit Court of Appeals made clear that if an IPA actually tries to leverage its numbers to demand better rates, it violates antitrust laws. If it follows the messenger model, it has no leverage. It is a “heads I win, tails you lose” regulatory structure designed to protect payers, not providers. The only exception is “clinical integration,” where providers genuinely merge their practices, share infrastructure, and accept joint financial risk. But this requires substantial capital investment and essentially means ceasing to be an independent practitioner. It is a legal pathway available mainly to large physician groups and hospital systems, not to solo therapists working out of rented offices. Part VI: Market Distortions and the Flight to Cash When a cartel sets a price below the market equilibrium, suppliers exit the formal market. This is precisely what has happened in psychotherapy. Mental health providers generally have lower overhead than surgeons. They do not need MRI machines or sterile surgical suites. And they face high consumer demand; the national mental health crisis ensures a steady stream of people seeking services. This gives them an “exit option” that proceduralists do not have. They can refuse to accept insurance and operate as cash-only businesses. The statistics are stark. Nearly 50 percent of psychiatrists do not accept commercial insurance, compared to less than 10 percent of other specialists. A 2023 survey indicated that 64 percent of private practice therapists planned to increase their cash-pay rates. Research published in Health Affairs Scholar found that patients are 10.6 times more likely to go out-of-network for mental health care than for medical/surgical care. This mass exodus is a rational economic response to RUC-suppressed rates. If the RUC says an hour of therapy is worth $100 via the RVU-to-dollar conversion, but the market demand is willing to pay $250, the provider will leave the RUC-controlled sector. They are not abandoning their profession; they are abandoning a pricing regime that values their work at less than half its market rate. Ghost Networks The RUC's pricing failure creates “Ghost Networks,” directories filled with providers who are ostensibly “in-network” but are functionally inaccessible. They are either full, not accepting new patients, retired, have moved, or simply do not respond to inquiries from insurance-based patients because the administrative burden of prior authorizations and clawbacks outweighs the suppressed fee. This is not a “shortage” of providers in the absolute sense. There is no shortage of therapists in private practice. There is a shortage of therapists willing to work at the RUC-determined price point. The insurance directories are graveyards of phantom availability, creating the illusion of access where none exists. The Cost Paradox The central thesis of the RUC's defenders is that they “control costs.” By strictly managing RVUs, they claim to save taxpayer money. In psychotherapy, this logic backfires catastrophically. By suppressing reimbursement rates to a level that drives providers out of the network, the RUC forces patients into the cash market. The theoretical in-network cost might be a $20 copay with the insurer paying $100. The actual out-of-network cost is $250 cash out-of-pocket, paid in full by the patient. Thus, the “cost of therapy” for the consumer skyrockets. Therapy becomes a luxury good, accessible only to those with disposable income. For the poor and middle class, the “cost” is effectively infinite, because the service becomes inaccessible. The RUC's cost-control measure for the system becomes a cost-multiplier for the patient. It shifts the financial burden from the risk pool, where it belongs, to the individual, where it causes maximum harm. The Signal to Students The RUC sends powerful economic signals to medical students making career decisions. When a student observes that a dermatologist or radiologist can earn $500,000 working regular hours, while a psychiatrist earns $240,000 handling emotional trauma and on-call emergencies, while a primary care doctor earns even less, the choice is clear for those motivated by financial security. The undervaluation of cognitive codes discourages the best and brightest from entering mental health and primary care. The cartel's pricing structure creates a perpetual labor shortage in the fields most needed for public health, while creating a surplus in high-margin procedural specialties. We then wonder why there are not enough psychiatrists, why primary care is in crisis, why mental health access is collapsing. The answer is in the price signal, and the price signal is set by a committee of proceduralists meeting behind closed doors. The Hands Are Tied The question “Why can't therapists start a union?” is not just a labor question. It is a window into the broken soul of American healthcare. We have built a system where a secret committee of proceduralists can legally fix prices to favor surgery over therapy, but a group of social workers cannot band together to ask for a living wage. We have utilized laws meant to break up Standard Oil to break up the solidarity of caregivers. The same regulatory framework that criminalizes therapist coordination provides legal cover for industry-wide price coordination by the most powerful medical specialties. The result is a regulatory environment that drives doctors crazy, burns out therapists, and leaves patients navigating a fragmented, assembly-line system that was never designed to heal them. It was designed to process them. Until we confront the legal architecture of this system, the RUC, the Sherman Act, the 1099 trap, we will remain powerless to change it. And the reality of therapy is that quick fixes, whether in treatment or in policy, usually end up costing us more in the end. Some states are beginning to push back. New York and California have implemented strict network adequacy standards requiring mental health appointments within 10 business days. These regulations force insurers to expand their networks, which means they must attract providers, which means they must raise reimbursement rates above the RUC/Medicare floor. It is effectively a state-level override of the RUC cartel, forcing capital back into the mental health labor market. The Medicare Payment Advisory Commission has long advocated for stripping the RUC of its power, proposing the use of empirical data, tax returns, payroll records, practice invoices, to set values automatically. But these are patchwork solutions to a systemic problem. The fundamental issue remains: we have created a healthcare system that knows the price of everything and the value of nothing. We have engineered a system where the only way to survive is to stop acting like a healer and start acting like a factory. And we have wrapped this system in a legal framework that criminalizes resistance while protecting the status quo. The hands are tied. But at least now we can see the ropes. Bibliography For those interested in the primary sources and legal texts that underpin this analysis, the following external resources provide high-trust verification of the claims made above: Goldfarb v. Virginia State Bar, 421 U.S. 773 (1975): The Supreme Court decision that ended the “learned profession” exemption from antitrust laws. Read the Oyez Summary. The Sherman Antitrust Act (15 U.S.C. §§ 1–7): The foundational text of US antitrust law prohibiting restraint of trade. Read the Document at the National Archives. North Texas Specialty Physicians v. Federal Trade Commission (5th Cir. 2008): A key ruling establishing that independent physicians cannot collectively bargain on fees without financial integration. Read the Court Opinion. FTC/DOJ Statements of Antitrust Enforcement Policy in Health Care (1996): The federal guidelines explaining the “Messenger Model” and the narrow exceptions for clinical integration. Read the Guidelines (PDF). The RUC (AMA/Specialty Society RVS Update Committee): The AMA's own description of the committee structure and its role in valuing physician work. Visit the AMA RUC Page. “Special Deal” by Haley Sweetland Edwards (Washington Monthly, 2013): An investigative deep-dive into how the RUC operates and its impact on primary care vs. specialty pay. Read the Investigation. The National Labor Relations Act (NLRA): The law governing the right to unionize, which specifically excludes independent contractors. Read the NLRA. Laugesen, Miriam J. Fixing Medical Prices: How Physicians Are Paid. Harvard University Press, 2016. The definitive scholarly analysis of the RUC's history, structure, and influence on American healthcare pricing. Government Accountability Office. “Medicare Physician Payment Rates: Better Data and Greater Transparency Could Improve Accuracy.” 2015. GAO's critical analysis of RUC methodology and conflicts of interest. Center for American Progress. “Rethinking the RUC.” 2015. Policy analysis of the RUC's structural bias against primary care and cognitive services. Health Affairs Scholar. “Insurance Acceptance and Cash Pay Rates for Psychotherapy in the US.” 2023. Empirical research on out-of-network utilization in mental health care. Medicare Payment Advisory Commission (MedPAC). “Report to the Congress: Medicare and the Health Care Delivery System.” 2024. Annual policy recommendations including proposals for reforming physician fee schedule methodology. Joel Blackstock, LICSW-S, is the Clinical Director of Taproot Therapy Collective in Hoover, Alabama. He specializes in complex trauma treatment and writes at GetTherapyBirmingham.com.  

Mark Weiss and Jason Almiro (Quantum Health Advisors) sit down for a candid conversation on the major changes in Medicare's 2026 Physician Fee Schedule—what's new, what's gone, and what entrepreneurial physicians need to know now.

In this episode of ACEP Nowcast, host Amy Faith Ho, MD, MPH, FACEP, talks to Michael Granovsky, MD, CPC, FACEP, about the new and final physician fee schedule that takes effect January 1. More links: Read more on ACEPNow.com. Revisit ACEP Nowcast podcast episodes.  View job opportunities at emCareers.

The Centers for Medicare & Medicaid Services (CMS) recently released the 2026 Medicare Physician Fee Schedule. And while that's not breaking news, the important news is that you and your team could benefit by understanding its hidden traps – so you can protect your revenue. During the next live edition of Monitor Monday, senior healthcare analyst Frank Cohen will reveal the latest developments in Medicare audit reforms and statistical extrapolation, including the Medicare Program Integrity Manuel (MPIM) standards, plus how artificial intelligence (AI) is changing audit selection for 2025.You and your team will receive expert analysis and practical guidance, as well as gain a better understanding of the true scope of improper payments.The weekly broadcast will also include these instantly recognizable features:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.Legislative Update: Adam Brenman, senior healthcare legislative affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

This week in the Breakroom, Jeffrey Davis and Rachel Hollander join Erin Fuller to break down major payment policies in the CY 2026 Medicare Physician Fee Schedule final rule.

The latest RADVOCACY Podcast hosted by RADPAC features Greg Nicola, MD, FACR, Chair of the American College of Radiology's ®️ Commission on Economics. Dr. Nicola discusses the 2023 Medicare Physician Fee Schedule proposed rule, as well as some of the upcoming challenges and efforts regarding commercial payers.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Jeff Byers welcomes Senior Editor Leslie Erdelack back to the pod to discuss the proposed rule change to the Medicare Physician Fee Schedule for 2026, which includes payment conversion factors for doctors, alternative payment models, add-on codes for Advanced Primary Care Management services, a new mandatory value-based payment model, and more.Order the August 2025 issue of Health Affairs.Join us for a live taping of A Health Podyssey on Tuesday August 12 where Rob Lott will discuss recent findings about changes in clinician's participation across Medicare value-based payment models with Kenton Johnston.Upcoming Events include:8/20: 340B w/ Sayeh Nikpay (INSIDER EXCLUSIVE)8/26: Provider Prices in the Commercial Sector: Independent Dispute Resolution (FREE TO ALL)9/23: Prior Authorization: Current State and Potential Reform (INSIDER EXCLUSIVE)View all Upcoming Events.Become an Insider today to get access to exclusive events like the ones highlighted above.Related Articles:PRESS RELEASE: Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule (CMS-1832-P)CMS proposes rule aligning Medicare physician payment with ‘Big Beautiful Bill,' MACRA (Healthcare Dive)CMS proposes 3.6% pay bump for docs, takes aim at chronic conditions in physician fee schedule (Fierce Healthcare)Physicians will see Medicare payments rise in 2026 (AMA)Medicare proposes ‘efficiency' pay cuts that would hit highly paid specialists the most (STAT News) Subscribe to UnitedHealthcare's Community & State newsletter.

In the third episode of this series, Dr. Andy Southerland discusses the latest Capitol Hill Report, which outlines the 2026 Medicare fee schedule proposal.  Stay updated with what's happening on the hill by visiting aan.com/chr.  Learn how you can get involved with AAN advocacy. 

This week in the Breakroom, Rachel Stauffer and Rachel Hollander join Maddie News to take a deep dive into the digital health and telehealth proposals in the Medicare Physician Fee Schedule. Read more in this week's Regs & Eggs blog post.

This week in the Breakroom, Jeffrey Davis and Rachel Hollander join Maddie News to break down major payment policies in the 2026 Medicare Physician Fee Schedule proposed rule. Read more in our regs & eggs blog post.

ACRO's SOAP (Spotlight on Advocacy and Policy) Podcast provides public policy awareness to the radiation oncology community. During this episode, our hosts Drs. Tarita Thomas and Anna Brown of the ACRO Government Relations & Economics Committee (GREC) discuss the development of the Medicare Physician Fee Schedule with Dr. Paul Wallner, fellow GREC member, Teri Bedard, Revenue Cycle Coding Strategies, and Jason McKitrick, Liberty Partners Group.

In part three of this three-part series, Dr. Jason Crowell and Max Goldman discuss potential legislative actions affecting the 2025 Medicare Physician Fee Schedule. Show references: Fee for Service Page Webinar sign up link Full Physician Fee Schedule Final Rule

In part one of this three-part series, Dr. Jason Crowell and Matt Kerschner discuss the key updates and changes to the Medicare Physician Fee Schedule for 2025. Show references: Fee for Service Page Webinar sign up link Full Physician Fee Schedule Final Rule  

Welcome to this episode of the TMA Practice Well podcast, hosted by Cheryl Krhovjak, Director of the TMA Education Center. In this insightful discussion, we are joined by Robert Bennett, TMA Vice President of Medical Economics, to delve into the significant impact of Medicare 2025 physician fee schedule. With over 65 million beneficiaries, Medicare is a key player in health care, and its spending is projected to surge in the coming years. Robert highlights the recent updates in the 2025 Medicare Physician Fee Schedule, including anticipated reductions in conversion factors unless Congress intervenes. This episode underscores the challenges faced by health care practices due to administrative burdens and payment cuts, which threaten patient access to physicians. The episode also discusses legislative efforts such as the Medicare Payment Access and Practice Stabilization Act of 2024 and the Strengthening Medicare for Patients and Provider Act, aimed at stabilizing physician payments and ensuring fair inflationary updates. Listeners are encouraged to advocate for these changes to protect their practice and patients. Additionally, discover the resources offered by the Texas Medical Association, including the Physician Payment Resource Center, to assist Texas physicians in navigating billing, coding, and payment challenges. Tune in for actionable insights and tips to help your practice thrive in the evolving healthcare landscape. Medicare Payment Reform Center Medicare Patient Outreach Flyer Physician Payment Resource Center (PPRC) 2025 Medicare Physician Fee Schedule Ondemand Webinar 

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Jeff Byers is joined by Jason Resendez, President and CEO of the National Alliance for Caregiving, to discuss the recent finalization of CMS's 2025 Medicare Physician Fee Schedule and how these policies will impact family caregivers and the integration of these individuals into the health care system.  Health Affairs's Research and Justice For All podcast returns for its second season, focusing on drivers of health. Check out the first episode.  Check out the 200th episode of A Health Podyssey featuring Leemore Dafny of the Harvard Business School discussing vertical integration.  Join Health Affairs on November 20 for a virtual event with John Bowblis examining how the loss of public health emergency funds challenges the financial viability of nursing homes.Related Articles:PRESS RELEASE: HHS Finalizes Physician Payment Rule Strengthening Person-Centered Care and Health Quality Measures 11/20/2024: Caregiver Nation Summit (Agenda and Virtual Attendance Options) Subscribe to UnitedHealthcare's Community & State newsletter.

Welcome to the Paint The Medical Picture Podcast, created and hosted by Sonal Patel, CPMA, CPC, CMC, ICD-10-CM. Thanks to all of you for making this a Top 15 Podcast for 4 Years: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://blog.feedspot.com/medical_billing_and_coding_podcasts/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Sonal's 13th Season starts up and Episode 11 features a Newsworthy update on the OIG Work Plan for October 2024. Sonal's Trusty Tip and compliance recommendations focus on reading and analyzing Final Rules as they are released. Sonal shares a few highlights from the 3,088-page Medicare Physician Fee Schedule Final Rule for 2025. Spark inspires us all to reflect on insight and wisdom based on the inspirational words of Mahatma Gandhi. Thanks to HCPro: Check out their Boot Camps: www.hcmarketplace.com ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Paint The Medical Picture Podcast now on: Spotify: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://open.spotify.com/show/6hcJAHHrqNLo9UmKtqRP3X⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Apple Podcasts: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://podcasts.apple.com/us/podcast/paint-the-medical-picture-podcast/id153044217⁠7⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Amazon Music: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://music.amazon.com/podcasts/bc6146d7-3d30-4b73-ae7f-d77d6046fe6a/paint-the-medical-picture-podcast⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Find Paint The Medical Picture Podcast on YouTube: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.youtube.com/channel/UCzNUxmYdIU_U8I5hP91Kk7A⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Find Sonal on LinkedIn:⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/sonapate/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ And checkout the website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://paintthemedicalpicturepodcast.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ If you'd like to be a sponsor of the Paint The Medical Picture Podcast series, please contact Sonal directly for pricing: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠PaintTheMedicalPicturePodcast@gmail.com --- Support this podcast: https://podcasters.spotify.com/pod/show/sonal-patel5/support

Rachel Stauffer joins Julia Grabo to discuss the virtual care provisions in CMS' recently released calendar year 2025 Medicare Physician Fee Schedule final rule.

ACRO's SOAP (Spotlight on Advocacy and Policy) Podcast provides public policy awareness to the radiation oncology community. During this episode, Drs. Tarita Thomas and Anna Brown, discuss the comment letter filed with CMS regarding the 2025 Medicare Physician Fee Schedule Proposed Rule. They are joined by Jason S. McKitrick, a Principal with DC based firm, Liberty Partners.

UCA's Advocacy efforts recently achieved a milestone - inclusion of Urgent Care in the 2025 Medicare Physician Fee Schedule publication issued by CMS.  This episode goes into more details about what that means, why it's important, what happens next, and when those efforts might directly impact Urgent Care centers.  Guests are Eric Zimmerman from McDermott+ and Kristin Rastatter of the Urgent Care Association.Links mentioned:https://urgentcareassociation.org/uc-advocacy/https://urgentcareassociation.org/about/the-people-behind-uca/kristin-rastatter/

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs Editor-in-Chief Alan Weil welcomes Liz Fowler, Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services, to A Health Podyssey to discuss the future of health care payments, CMMI's specialty care strategy, mandatory models versus voluntary alternative payment models, CMS' newly-proposed Medicare Physician Fee Schedule for 2025, and more!Related Articles from Liz Fowler on Health Affairs:The CMS Innovation Center's Strategy To Support Person-Centered, Value-Based Specialty Care: 2024 UpdateAdvancing Health Equity Through Value-Based Care: CMS Innovation Center UpdateUpdate On The Medicare Value-Based Care Strategy: Alignment, Growth, EquityOrder the July 2024 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone. Subscribe to UnitedHealthcare's Community & State newsletter.

Chemyeeka Tumblin, a Licensed Marriage and Family Therapist specializing in Perinatal and Maternal Mental Health, outlines the importance of Black Maternal Health Week; Jeffrey Ekoma, ASTHO's Senior Director for Government Affairs, discusses ASTHO's FY25 Governmental Public Health Appropriations Book; and an ASTHO resource will take you through all the changes to the Medicare Physician Fee Schedule. CDC Webpage: Working Together to Reduce Black Maternal Mortality ASTHO Webpage: FY25 Governmental Public Health Appropriations Book ASTHO Webpage: Changes to 2024 Medicare Physician Fee Schedule for CHI Services ASTHO Webpage: Legislative Alerts ASTHO Webpage: Stay Informed  

How the AMA is addressing the most significant problems facing doctors in medicine today: Medicare payment reform, fixing prior authorization, reducing physician burnout, as well as making healthcare technology an asset not a burden. AMA Senior Vice President of Advocacy Todd Askew joins AMA CXO Todd Unger for a live chat at this year's National Advocacy Conference.

By Adam Turteltaub The 2024 CMS Medicare Physician Fee Schedule extends no less than ten different pandemic flexibilities related to telehealth. In this podcast, Randi Seigel, partner and Jared Augenstein, managing director, at Manatt take us through all of them, including in-person visit requirements, audio-only services, physician supervision and opioid treatment. They also address: Changes in the structure of the telehealth services list Changes to payment by place of services Remote psychological and therapeutic monitoring Enrollment and revocation A new opportunity for payments for social needs of Medicare beneficiaries Listen in to learn more about what's new, what's the same, and what will sunset at the end of 2024.

Jeffrey Davis joins Julia Grabo to discuss the so-called "doc fix" that would prevent some or all of the 3.37% cut to the Medicare Physician Fee Schedule conversion factor. They also explore what congressional action would look like and address why it's a hot topic now.

The real-world consequences of declining Medicare physician payment. From, 2001 to 2023, Medicare payment has declined 26% when adjusted for inflation. Alice Coombs, an anesthesiologist and internist at Virginia Commonwealth University Health joins to discuss the ways this underpayment impacts physicians and patient care, including longer wait times and less access to care. Dr. Coombs also shares how physicians can advocate for change based on her experience as the president of the Medical Society of Virginia. American Medical Association CXO Todd Unger hosts.

In this episode of the MGMA Week in Review podcast, we welcome MGMA editor and writer Colleen Luckett to the show to share her thoughts on the latest MGMA Stat on the 2024 Medicare Physician Fee Schedule. Sources: MGMA Stat: https://www.mgma.com/mgma-stat/social-determinants-of-health-a-driving-force-in-medical-group-data-collection Physician Fee Schedule: 2024 Medicare Physician Fee Schedule Resources: MGMA Stat: mgma.com/stat Ask an Advisor: www.mgma.com/ask-an-advisor MGMA Membership: www.mgma.com/membership MGMA Advocacy: www.mgma.com/advocacy MGMA Consulting: www.mgma.com/consulting/overview If you would like additional tools and resources related to medical practice leadership or you have stories to share with us, email us at podcasts@mgma.com or email Daniel Williams directly at dwilliams@mgma.com. Thank you again for taking the time to listen to the MGMA podcast network.

Medicare must change, and the AMA is fighting nonstop to make payment reform a reality. Chair of the AMA Board of Trustees Willie Underwood III, MD, MSc, MPH, joins to discuss the AMA's advocacy to fix Medicare now, including the campaign's wins to date and what's next. American Medical Association CXO Todd Unger hosts.

Physician Medicare payment is down 26% since 2001, when adjusted for inflation. When you look at the numbers, it's clear that the government needs to fix Medicare now for physicians. Jason Marino, director of Congressional affairs for the AMA, joins to break down the facts and figures and explain why reforming Medicare physician payment just makes sense. American Medical Association CXO Todd Unger hosts.

Dive into the current cardiology coding landscape and what lies ahead, from understanding "incident to" billing practices and ICD-10 modifications, to navigating the 2024 Medicare Physician Fee Schedule and addressing prevalent denial trends facing cardiology practices. Julie Graham, Infinx Senior Coding Manager, joins us with her vast experience of over 20 years in the field. She sheds light on these topics and offers actionable insights to overcome common challenges. Brought to you by www.infinx.com

Matt Kershner, Director, of Regulatory Affairs & Policy, at the American Academy of Neurology, discusses the 2024 Medicare Physician Fee Schedule Proposed Rule. Show references: https://www.aan.com/advocacy/capitol-hill-report This episode was sponsored by the ExTINGUISH Trial for NMDAR Encephalitis: Call 844-4BRAIN5 to refer patients.      

Howie and Harlan are joined by Melissa Davis, a Yale radiologist and a graduate of Yale SOM's MBA for Executives program, to discuss the ‘whoa' moments and the weaknesses she has encountered using artificial intelligence to help interpret scans. Harlan reflects on the slow progress toward a healthcare system that rewards value rather than volume; Howie reports on new treatments for Alzheimer's disease.  Links: “Robert F. Kennedy Jr. suggests covid was designed to spare Jews, Chinese people” “The Medicare Physician Fee Schedule and Unethical Behavior” “Vinod Khosla: Machines will replace 80 percent of doctors” “Affirmative action ruling raises concerns over impact on medical school diversity” Yale School of Management: MBA for Executives Sepsis DX, co-founded by Melissa Davis “Donanemab in Early Symptomatic Alzheimer Disease: The TRAILBLAZER-ALZ 2 Randomized Clinical Trial” “Editorial: Amyloid-Targeting Monoclonal Antibodies for Alzheimer Disease” Learn more about the MBA for Executives program at Yale SOM. Email Howie and Harlan comments or questions.

Alex Kirkland joins Mark Reiboldt to discuss the state of physician compensation and what the future may hold. Hospitals have competed for physician market share in the post-pandemic world, and the influx of private equity investment alongside rising costs has pushed the survey data approach of funding physician compensation models to unsustainable levels.   Episode Synopsis  Many external factors have impacted physician compensation over the past several years. The extensive list includes pandemic-era volume reductions, volatile survey data, Medicare Physician Fee Schedule changes, rising inflation, and the list goes on!  If there is any constant, it is that change is inevitable.  With so much uncertainty, how can healthcare systems possibly plan for the future in terms of a sound physician compensation strategy? The answer lies in understanding expected shifts in the physician workforce, and the need for a nimble compensation structure that can adapt to market forces.   Extras  ·         Survey Says… What to Expect from the 2021 Market Survey Data (https://cokergroup.com/survey-says-what-to-expect-from-the-2021-market-survey-data/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-115&utm_content=link-website&utm_campaign=provider-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=article&utm_marketing_tactic=awareness) ·         Compensation Best Practices for Physician Enterprises (https://cokergroup.com/compensation-best-practices-for-physician-enterprises/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-115&utm_content=link-website&utm_campaign=provider-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=white-paper&utm_marketing_tactic=solution) ·         How do we address provider compensation misalignment? (https://cokergroup.com/case-study-provider-compensation-misalignment/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-115&utm_content=link-website&utm_campaign=provider-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=case-study&utm_marketing_tactic=solution) ·         How are the 2023 E/M guideline changes impacting your organization? (https://cokergroup.com/2023-e-m-impact-calculator/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-115&utm_content=link-website&utm_campaign=provider-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=calculator&utm_marketing_tactic=tool)   Podcast Information  Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review! We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.  ·         Please email us: feedback@cokergroup.com ·         Connect with us on LinkedIn: Coker Group Company Page ·         Follow us on Twitter: @cokergroup ·         Follow us on Instagram: @cokergroup ·         Follow us on Facebook: @cokerconsulting

Learn how the AMA is #FightingForDocs and access resources from the AMA Recovery Plan for America's Physicians by visiting: https://www.ama-assn.org/recoveryStay up to date on all the latest advocacy news by subscribing to AMA Advocacy Update: https://www.ama-assn.org/advocacy-update

Hospitals and health systems rely heavily on published compensation data for establishing their provider compensation and as part of their documentation for regulatory compliance. Both the pandemic and the Medicare Physician Fee Schedule continue to pose questions as it relates to recently published benchmarks. Emma Miller, FTI Consulting, speaks with representatives from four of the nationally recognized survey companies about the most recent benchmarks and how the data should be utilized. Emma's panel includes Elizabeth Siemsen, AMGA Consulting, Maria Hayduk, ECG Management Consultants, Michelle Mattingly, MGMA, and Bob Madden, SullivanCotter. From AHLA's Hospitals and Health Systems Practice Group.To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.

The 2023 Medicare Physician Fee Schedule, which takes effect Jan. 1, and brings with it a mixed bag of consequences for physicians. TMA experts answer physician member questions about the coming changes. Claim CME for this episode and get the links to resources discussed at www.texmed.org/education.

Beth Balcom, Brandt Jewell, Alex Kirkland, and Richard Romero presented this webinar for the American Health Law Association. Our team will cover upcoming billing and coding changes affecting healthcare organizations in three areas: coding and compliance, operations, and finance.   Podcast Information  Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review! We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.  Please email us: feedback@cokergroup.com Connect with us on LinkedIn: Coker Group Company Page Follow us on Twitter: @cokergroup Follow us on Instagram: @cokergroup Follow us on Facebook: @cokerconsulting   Episode Synopsis  Upcoming billing and coding changes will affect healthcare organizations in three areas: coding and compliance, operations, and finance. Our team will cover these areas as they discuss how billing changes will impact physician practice operations and economics, including provider compensation and fair market value considerations.   Learning Objectives Understand the financial impact of critical changes within the Medicare Physician Fee Schedule proposed rule and what they may mean from a valuation perspective. Discuss the operational implications and considerations resulting from the Medicare Physician Fee Schedule proposed rule. Provide an overview of the expected coding changes and associated compliance considerations.   We recommend you speak with your key stakeholders about performing three actions to prepare for the upcoming changes which go into effect on January 1, 2023: Develop a coding communication plan that considers tools and checklists to help front-line resources acclimate to the changes Audit current EHR scheduling templates to ensure they consider the changes Conduct a chart audit to verify the accuracy of coding and documentation   If Coker Group can assist you with developing a plan or implementation for any of the above, please get in touch with us to schedule a free consultation to discuss the specific needs of your client(s) or organization. Book Your Free Consultation ---> https://cokergroup.com/contact/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-110&utm_content=book-your-free-consultation&utm_campaign=coding-assessments&utm_source_platform=podcast-app&utm_creative_format=link&utm_marketing_tactic=contact   Extras Major Changes to Split/Shared Billing Affect Advanced Practice Providers and Physicians (https://cokergroup.com/major-changes-to-split-shared-billing-affect-advanced-practice-providers-and-physicians/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-110&utm_content=major-changes-to-split-shared-billing-affect-advanced-practice-providers-and-physicians&utm_campaign=physician-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=blog&utm_marketing_tactic=awareness) How the CY 2022 PFS Final Rule Affects Split/Shared Visits and Critical Care Services (https://cokergroup.com/how-the-cy-2022-pfs-final-rule-affects-split-shared-visits-and-critical-care-services/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-110&utm_content=how-the-cy-2022-pfs-final-rule-affects-split-shared-visits-and-critical-care-services&utm_campaign=physician-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=blog&utm_marketing_tactic=awareness) Episode 107: How will Split/Shared Visits Change Between APPs and Physicians? (https://cokergroup.com/episode-107-how-will-split-shared-visits-change-between-apps-and-physicians/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-110&utm_content=how-will-split-shared-visits-change-between-apps-and-physicians&utm_campaign=physician-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=podcast&utm_marketing_tactic=awareness)

Matt Kershner, Director of Regulatory Affairs, discusses the Medicare Physician Fee Schedule Final Rule. Show References: https://www.aan.com/advocacy This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information.

Dr. Bruce Cohen discusses the new Medicare Physician Fee Schedule Final Rule. Show references: https://www.aan.com/practice/medicare-fee-for-service This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information.

Long-awaited and highly anticipated, the Centers for Medicare & Medicaid Services (CMS) Medicare Physician Fee Schedule Final Rule for 2023 released this past week supports the expansion of access to behavioral health and cancer screening, while promoting health equity.The timing of this Final Rule brings to mind the loss of actor Chadwick Boseman of Black Panther fame. Boseman died in 2020, following his battle with colon cancer – an issue addressed in the Final Rule with a focus on cancer screening, as colon and rectal cancers continue to be a leading cause of death in the U.S., with even higher numbers of new cases and death rates for Black Americans, Native Americans, and Alaskan Natives. Reporting our lead story during the next live edition of Talk Ten Tuesdays will be senior healthcare consultant Sharon Easterling, who is writing a series of articles for ICD10monitor on the experience of Black Americans dealing with the country's healthcare system.Other segments during the live broadcast will include the following:RegWatch: Stanley Nachimson, former CMS career professional-turned-well-known healthcare IT authority, will report on the latest regulatory news coming out of Washington, D.C.Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will report on the latest coding news.Journaling John: John Zelem, MD, FACS, founder and CEO of Streamline Solutions Consulting, will continue with his journal entries.News Desk: Timothy Powell, CPA, will anchor the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer,MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.  The Foundation of Daily Health, AG1 by Athletic GreensUnlock Your Free One Year Supply of Vitamin D3+K2 and 5 free Travel Packs

The Medicare Physician Fee Schedule Final Rule for 2023 includes a provision for telehealth services – this following the temporary expansion of telehealth to beneficiaries during the COVID -19 public health emergency (PHE) that began March 1, 2020. Once the temporary PHE waivers terminate, what are the plans the Centers for Medicare & Medicaid Services (CMS) has for covering telehealth services for Medicare beneficiaries?Join 3M consultant Colleen Deighan-Ejak during the next live edition of Monitor Mondays, when she will outline what is included in the Final Rule for Medicare telehealth services.  Other segments will include these instantly recognizable broadcast features:The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.SDoH Report: Tiffany Ferguson, a subject matter expert on the social determinants of health (SDoH), will report on the news that's happening at the intersection of healthcare regulations and the SDoH.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.Legislative Update: Matthew Albright, chief legislative affairs officer for Zelis, will report on current healthcare legislation.The Foundation of Daily Health, AG1 by Athletic GreensUnlock Your Free One Year Supply of Vitamin D3+K2 and 5 free Travel Packs

In this episode, advocacy leaders from the AAOS review proposed payment policy changes for 2023 in the inpatient and outpatient setting including ongoing cuts to reimbursement in the annual Medicare Physician Fee Schedule. They summarize each of the three regulatory rules, highlight changes specific to musculoskeletal care, then discuss the careful balance between stabilizing the system in the short-term while working towards a permanent fix that addresses growing health care costs and incentivizes value-based care.  Guest: Karl Koenig (Texas), MD, FAAOS, Chair, AAOS Health Care Systems Committee Host: Douglas Lundy, MD, MBA, FAAOS, Chair, AAOS Advocacy Council Notes: Issue page in the AAOS Advocacy Action Center: https://www.aaos.org/advocacy/advocacy-action-center/payment-policy-changes/ Episode 23 - Economic Effects of Medicare Pay Cuts (recorded Oct. 2021): https://www.aaos.org/publications/the-bone-beat-orthopaedic-podcast-channel/the-bone-beat-advocacy-podcast/episode-23/ Special Episode - Impact of Payment Policy Changes (recorded Sept. 2020): https://www.aaos.org/publications/the-bone-beat-orthopaedic-podcast-channel/the-bone-beat-advocacy-podcast/episode-9/

In this episode of the MGMA Week in Review podcast, we feature articles on stress and burnout, the 2023 Medicare PFS, and FDNY dealing with 9/11-related illnesses. Sources in this episode: Stress and burnout for healthcare leaders -- https://www.mgma.com/data/data-stories/stress-and-burnout-a-growing-concern-for-healthcar MGMA and the 2023 Medicare Physician Fee Schedule proposals -- https://mgma.com/news-insights/press/september-6,-2022-mgma-provides-comprehensive-comm?utm_source=nl-gov-kh-washington-connection-2022-09-08&utm_medium=email&utm_campaign=government-affairs&mkt_tok=MTQ0LUFNSi02MzkAAAGGu_UgilrjV0h2lSrChReRjCibi8TQmIdU39CQ7YIBFDXu9vXD1cG2qnQkBNotRFl-v7Lyrw-HI2gXFNJBkRjkW--N-ZRY4qf8sABuVMIeBA FDNY fatalities from post-9/11 illnesses -- https://abc7ny.com/fdny-911-september-11-world-trade-center/12216375/ Additional resources: To keep up with the latest healthcare legislation, visit mgma.com/advocacy. If you want to become part of the discussion, join the MGMA STAT panel by texting “stat” to 33550 or visit www.mgma.com/data/data-stories/mgma-stat-overview. Keep up with the latest industry news by subscribing to the MGMA Insights Newsletter at mgma.com/insightsnewsletter. Listen to our podcasts at www.mgma.com/listen. Join us at the MPE: Leaders Conference in Boston, Oct. 9-12. To register or learn more go to mgma.com/events/medical-pract…e-leaders-conference If you have a story you want to share with us, email us at podcasts@mgma.com.

Matt Kershner, Director of Regulatory Affairs at the American Academy of Neurology, discusses the 2023 Medicare Physician Fee Schedule Proposed Rule.

What you'll get out of this episodeCarrie talks with American Telemedicine Association (ATA) Vice President of Public Policy Kyle Zebley about how upcoming laws and policies will impact the future of virtual care.Listen to Discover: What the significance of the new bill, H.R. 4040, that was recently passed by the US House of Representatives, is and its chances of being signed into law What this new bill left out with respect to priorities within the telehealth stakeholder community How the proposed Medicare Physician Fee Schedule could shape virtual care in 2023 What kind of movement we're seeing in all 50 states around telehealth and virtual care policy About Our GuestKyle Zebley is Vice President of Public Policy at the American Telemedicine Association (ATA) and Executive Director of ATA Action. He is working with and on behalf of ATA and ATA Action members and like-minded organizations to eliminate barriers to the expansion of telehealth and ensure patients, providers, and payers can realize the benefits of virtual care.Previously, Kyle was the Chief of Staff in the Office of Global Affairs (OGA) at the U.S. Department of Health and Human Services (HHS). He collaborated with senior leadership from HHS, the White House and other cabinet departments to develop, advise, and promote U.S. global health policy, including in such policy areas as drug pricing, medical devices, global health security, and non-communicable diseases. Prior to HHS, he worked in Congress as a Legislative Director, leading a legislative team in developing policy and drafting legislation, particularly on matters concerning the House Committee on Ways and Means, the House Committee on the Budget and the House Committee on Education and the Workforce. Kyle started his career in Washington, D.C. as a Research Assistant at Public Opinion Strategies, where he worked on campaign strategies for clients running for U.S. President, U.S. Senate, the U.S. House of Representatives, state governor and state legislatures. Kyle is a sought-after policy expert and is frequently quoted in major media coverage on the topic of telehealth, including the Associated Press, Bloomberg, Kaiser Health News, Modern Healthcare, NPR, and Roll Call. In January 2022, Kyle was named by Politico as one of the “Four Washington players poised to shape digital health in 2022”.About the American Telemedicine AssociationAs the only organization completely focused on advancing telehealth, the ATA is committed to ensuring that everyone has access to safe, affordable, and appropriate care when and where they need it, enabling the system to do more good for more people.Additional Resources The American Telemedicine Association: “Telehealth. Is. Health. ATA is working to transform health and care through enhanced, efficient delivery.” ATA Action: “ATA Action, the ATA's affiliated trade organization, is our proactive response to the need for expanded advocacy in 2022 and the years to come. “ Connect with Kyle on LinkedIn Join the ConversationAre you a healthcare innovator? Tell us what topics and people you'd like us to cover in future episodes:Decoding Healthcare Innovation on LinkedInDecoding Healthcare on TwitterFollow our daily updates on LinkedIn:CarrieRebeccaAbout Your HostsCarrie Nixon and Rebecca Gwilt are partners at Nixon Gwilt Law, a healthcare innovation law firm exclusively serving Providers, Digital Health Companies, and Life Science Businesses seeking to transform the way we receive and experience healthcare. Find out more at NixonGwiltLaw.com.

AMA Senior Vice President of Advocacy Todd Askew discusses the latest advocacy efforts on Medicare physician payment reform and protecting patients' reproductive rights with American Medical Association CXO Todd Unger. Stay up to date on all the latest advocacy news by subscribing to AMA Advocacy Update: https://www.ama-assn.org/advocacy-news Details on AMA's Medicare payment principles webinar here: https://www.ama-assn.org/practice-management/medicare-medicaid/ama-advocacy-insights-webinar-series-medicare-payment

Aletheia Lawry, General Counsel, NextCare Holdings, Inc., speaks with Tony Kouba, Principal, ECG Management Consultants, and Kelsey Jernigan, Partner, K&L Gates LLP, about some of the recent changes to the Medicare Physician Fee Schedule (MPFS) and how provider compensation programs are responding. They discuss the split in how health systems are using the MPFS, how 2021 compensation data surveys will be impacted, and how compensation structures may change as more health systems move to value-based care. Sponsored by ECG Management Consultants.

Alex Kirkland and Matt Jensen join Mark to talk about the latest evaluation and management code updates to the Medicare Physician Fee Schedule. The Centers for Medicare and Medicaid Services (CMS) decreased the conversion factor for evaluation and management (E/M) codes for 2022.     Podcast Information Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review! We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.  Please email us: feedback@cokergroup.com Connect with us on LinkedIn: Coker Group Company Page Follow us on Twitter: @cokergroup Follow us on Instagram: @cokergroup Follow us on Facebook: @cokerconsulting   Episode Synopsis CMS increased the RVUs for which they reimburse outpatient E/M services and decreased the conversion factor to remain budget neutral. The conversion factor cuts will affect reimbursement for all services in the fee schedule to increase reimbursement for more cognitive E/M services. Organizations with RVU-based compensation plans need to revalue their wRVU rates to remain economically aligned with the fee schedule, especially if their provider compensation plans tie to wRVU values in the most recent Medicare Physician Fee Schedule. Click to listen to the episode.   Extras 2022 E/M Coding Calculator How the CY 2022 PFS Final Rule Affects Split/Shared Visits and Critical Care Services

Health Regulatory Update: Medicare Physician Fee Schedule Impact on Physician Compensation Effective at the start of 2021, the Centers for Medicare & Medicaid Services increased the work relative value units (“wRVUs”) allocated to several evaluation & management physician services. In this podcast, our Fraud & Abuse attorneys discuss the Stark and Anti-Kickback impact of these...

Up to 10% reimbursement cuts may be coming for Medicare Part B for occupational and physical therapy service on January 1, 2022. This is in addition to the OTA Modifier. Up to 6% cuts may be coming for Medicare Part A. Write your legislators today at www.aota.org/takeaction Here is my article on last years Medicare cuts that talk a bit more about the Medicare Physician Fee Schedule https://amplifyot.com/medicaretherapycut/ --- Send in a voice message: https://anchor.fm/amplifyot/message Support this podcast: https://anchor.fm/amplifyot/support

In this episode Sean and Scott Kraft discuss a few of the more pressing sections of the MPFS 2022 Proposed Rule including the Conversion Factor reduction and clinical labor cost reductions (Potential Specialty Financial Losers), Changes to Physical and Occupational Therapy and the use of PTAs and OTAs, and Split/Shared Service propsed rule changes. This is definitely not an episode you want to miss.