Federal health policy, measured in what it changes for your practice.
Each update is graded by direction, dated by when it takes effect and paired with the steps a practice can take now. CMS payment rules, Medicare and Medicaid policy, compliance obligations and FDA actions.
The final CY 2027 Physician Fee Schedule sets the main conversion factor at $32.63, a deeper cut than July's proposal. CMS also replaces G2211 with a percentage-based modifier and gives practices two more years before traditional MIPS ends.
The change Non-QP conversion factor falls 2.31% to $32.63; QP factor falls 1.83% to $32.95
First steps for your practice
Load the 2027 conversion factors ($32.63 non-QP, $32.95 QP) into your Medicare fee schedule and revenue projections before January 1
Retrain coders to replace G2211 with modifier B1 (or B2 for Shared Savings Program and LEAD ACO participants) on 2027 E/M claims
Flag same-day modifier 25 E/M visits billed with 0-day global procedures, which will be paid at 80% when they are the lower-paid service
The final health IT rule removes 14 of 60 certification criteria, including the automated numerator and measure-calculation tests that sit inside the MIPS CEHRT definition, but keeps privacy and security criteria and gives Direct and C-CDA exchange until 2030.
The final CY 2027 ESRD rule keeps the 8,000-treatment low-volume expansion, gives newly eligible facilities until December 31 to attest, and raises the labor-related share to 63.5%, which trims payment in low-wage areas.
A proposed rule published October 8 would undo parts of the 2023 CLIA personnel standards that office-based physicians found hardest to meet, drop twice-yearly director site visits, give board-certified dermatologists a direct route to direct Mohs labs and write remote data review into regulation.
CMS expects 34 million people in Medicare Advantage next year, nearly half of Medicare. The national plan count barely moves, but Florida and Ohio lose dozens of MA plans while Tennessee gains, and open enrollment starts October 15.
The Treasury, Labor and HHS departments finalized changes to the Transparency in Coverage rules on October 6. Insurers will post negotiated rates by provider network, drop rates a practice is unlikely to be paid, and from July 2028 list which clinicians were actually paid for each service.
The mandatory model ties manufacturer rebates on some high-spend physician-administered drugs to prices in 19 other countries. Practices keep buying and billing as usual, but Medicare will pay a larger share of each claim for patients in randomly chosen ZIP codes.
A Mississippi hospital wrongly counted as a rural emergency hospital forced five correction notices between September 29 and October 1. The changes are small, and they land with a corrected ICD-10 code set and new rehab therapy timing rules.
An inspector general audit issued September 14 projects 27 erroneous claims across $62 million in Medicare payments. A smaller audit of a South Carolina hospital, with no projection, shows where the line falls, and 2027 appeal thresholds are now set.
Reporting and documentation obligations: MIPS and quality programs, prior authorization, OIG guidance, Stark and anti-kickback rules, HIPAA and information blocking.
CMS rulemaking and Medicare legislation: the physician fee schedule, telehealth, Medicare Advantage policy that reaches providers, and the payment fixes Congress debates.