Congress has passed and the President has signed a Continuing Resolution (CR) to end the 43-day federal government shutdown and fund the government through January 30, 2026. As part of this package, Medicare telehealth flexibilities that expired on October 1 are now restored and extended through January 30, 2026. Additionally, telehealth services delivered during the shutdown will be covered retroactively.

CMS finalized the 2026 Medicare Physician Fee Schedule (PFS) rule on October 31, 2025. The rule updates payment policies, practice expense calculations, telehealth rules, and other Medicare Part B provisions.  This rule goes into effect January 1, 2026.

Telehealth is not gone, but the telehealth flexibilities introduced during the COVID-19 pandemic, which significantly expanded Telehealth, expired September 30, 2025. Several bills were introduced to extend Telehealth services but did not pass in Congress. This reverts Telehealth regulations for CMS (Centers for Medicare and Medicaid Services) to pre-pandemic rules.

Physician practices are experiencing a sharp increase in systematic downcoding by major commercial payors. This trend, driven largely by AI-powered algorithms, is resulting in significant revenue loss, higher administrative burden, and frustration for practices.

Cigna is significantly changing its commercial reimbursement policy for the Evaluation Management Service policy. This change goes into effect on October 1, 2025.

A $2.8 billion dollar class-action anti-trust settlement was reached between the plaintiffs (physicians, hospitals, large health systems, and provider organizations) and the Blue Cross and Blue Shield system (BCBS).

The Centers for Medicare & Medicaid Services (CMS) released their proposed rule on July 14, 2025 that will impact Medicare physician payments beginning January 1, 2026.

Medicare will have two separate conversion factors in 2026.

Medicare Advantage Plans are one alternative for Medicare beneficiaries in place of Medicare Part B (traditional Medicare). Most Medicare Advantage (MA) plans offer additional benefits such as Medicare drug coverage, dental coverage, and other types of services to Medicare patients beyond the usual coverage under the Medicare Fee for Service program.

It is not too early to begin preparing for the new Category III CPT codes, which will be implemented on July 1, 2025. As a reminder, Category III codes are temporary codes created for emerging technologies, procedures, and other services.

Staying up to date on the ever-changing regulations and requirements of coding and documentation can be challenging.

Here are some essential ways that everyone from clinical providers to coders,  billing and revenue staff,  compliance, and even IT personnel can help ensure that the organization as a whole operates in an effective, profitable and legally compliant manner.