Medicare Enrollment, Prior Authorization Rules, Internal Medicine & Primary Care Coding - 2025 Updates

Session 1: Medicare Enrollment in 2025 - Understand Submission Options, Provider's Eligibility, Application Type & Common Errors

Pre-recorded Webinar (Get instantly)

Duration - 60 Mins

Speaker - Toni Elhoms

The process of enrolling with Medicare as a provider/organization can be incredibly tedious and time-consuming.  Even though Medicare is the largest insurer in the country, the number of new Medicare enrollment applications continues to decline due to the enormous complexities surrounding enrollment application requirements.  The cost of getting these enrollment application submissions wrong can have systemic consequences on an organization, including cash flow delays, credentialing issues, coding issues, denial management issues, patient satisfaction, and even impact quality scores.  In this webinar, we discuss the submission options, which providers are eligible for Medicare enrollment, each application type applicable in 2025, how to navigate the 2025 complicated form sections, key terminology, what ancillary documentation is needed with enrollment submission, applicable fees, most common errors, and best practice tips for successfully completing the 2025 CMS 855 forms.

Webinar Objectives

• Dissect the various Medicare enrollment types in 2025
• Outline a sample workflow for completing Medicare enrollment in 2025
• Review CMS Form 855A application together
• Review CMS Form 855B application together
• Review CMS Form 855I application together
• Review CMS Form 855O application together
• Discuss the most challenging 855 form sections in 2025
• Review new process for reassigning benefits to organizations in 2025
• Review the ancillary documentation required with 855 enrollment submission
• Discuss the most common rejections and errors with 855 form submissions

Webinar Agenda

• Discuss CMS 855 enrollment submissions applicable in 2025
• Review CMS 855A, 855B, 855I and 855O Applications in 2025
• Discuss the most challenging CMS 855 form fields and highlight complicated sections
• Review strategies to complete the CMS 855 forms accurately in 2025
• Understand the ancillary documentation required to be attached to the CMS 855 application submission in 2025
• Discuss most common rejections with CMS 855 form submissions in 2025
• Discuss best practice tips with CMS 855 form submissions in 2025

Webinar Highlights

• Understand the CMS 855 enrollment submission process in 2025
• Recall CMS 855A, 855B, 855I and 855O Application requirements in 2025
• Recall the most complicated sections on the CMS 855 applications in 2025
• Recall strategies to complete CMS 855 forms accurately in 2025
• Recall ancillary documentation required with CMS 855 enrollment submission in 2025
• Avoid common rejections and errors with CMS 855 form submissions in 2025
• Recall best practice tips for CMS 855 form submissions in 2025

Session 2: CMS Prior Authorization Rules: Tactics to Fight Back and Win

Live - January 30, 2025

Time - 1:00 PM ET | 12:00 PM CT

Duration - 60 Mins

Speaker - Osato F. Chitou, Esq.

Originally focused on the costliest types of care, Payors now commonly require Prior Authorization for many mundane medical encounters, including basic imaging and prescription refills. Thus, PA is no longer used as a method to limit wasteful use of resources, but rather may be used as a tool that prevents patients from getting the vital care they need.

CMS recently finalized the Interoperability and Prior Authorization Final Rule. This final rule establishes requirements for Payors to streamline the prior authorization (PA) process. While prior authorization can help ensure medical care is necessary and appropriate, providers have been vocal that it is often an obstacle to necessary patient care when providers are forced to navigate complex and widely varying Payor requirements or face long waits for decisions. Beginning primarily in 2026, impacted Payors will be required to send prior authorization decisions within 72 hours for expedited (i.e., urgent) requests and seven calendar days for standard (i.e., non-urgent) requests for medical items and services. While these future requirements will be critical in expediting Payor decisions related to patient care, there are techniques that providers can utilize today to help reduce their prior authorization burdens without compromising patient care.

Webinar Objectives

PA can delay treatment and impact optimal patient health outcomes. To reduce these negative consequences for both patients and physicians, practices can minimize the impact of PA in their operations by developing efficiencies and implementing best practices to navigate the dizzying landscape of Payor PA rules.

Webinar Highlights

• Understand CMS Final Rule and what it means for Providers
• Understand ways to reduce the prior authorization burden
• Understand practice operations that can make your prior authorization process more efficient
• Understand the advantages and disadvantages of the myriad Prior Authorization submission methods
• Understand the procedures and medications that likely to trigger prior-authorization requirements 
• Understand how to respond to an inappropriately denied prior authorization

Session 3: Internal Medicines Updates and Primary Care Updates

Live - February 06, 2025

Time - 1:00 PM ET | 12:00 PM CT

Duration - 60 Mins

Speaker - Jill M. Young

Entering into 2025, the status of Telehealth Visits is in a very unusual place.  CPT has created new codes for Telehealth services.  Unfortunately, CMS/Medicare will not be allowing these services and should still be billed with the appropriate E&M services as you have been. The Physician Fee Schedule Final Rule for 2025 had much information about telehealth for the new year.  It did not showcase that without Congress passing legislation regarding telehealth originating location only patients in certain rural and underserved areas will be eligible to participate in telehealth services.  That this one aspect of telehealth services, location of the patient, would revert to pre-Covid-19 status.  Congress did pass the American Relief Act of 2025, but it only extends the location flexibility for 90 days. 

Other changes for Primary Care and Internal Medicine offices for 2025 from the Medicare for 2025 include a new add on code strictly for use by infectious disease specialists in the hospital or observation setting.  CMS/Medicare has also changed its policy, so you are now allowed to bill the complexity add on code with preventative services as they have defined. 

The process for Certification of Therapy plans of treatment is seeing major changes along with changes to the supervision for PT and OT assistants.

Webinar Objectives

Each year changes to the to the ICD-10-C system are released.  The changes to CPT codes are released by the AMA and then CMS/Medicare releases updates to codes that are on the physician fee schedule.  All offices need to be aware of the changes to understand how they affect their office process, their employees and their providers on a day-to-day basis.  This webinar objective is to give an overview of all the changes specialized for Primary Care offices (Family Practice and Internal Medicine) so you can focus on only those changes that affect you. 

Webinar Agenda

The session will start with a telehealth update – discussing where are we with the new CPT codes and where is Congress in their legislation for extending the telehealth’s geographical restrictions.

Other changes created by CMS/Medicare’s Physician Fee Schedule Final Rule will then take place such as clarifying changes to the add-on complexity code for E&M services and the new complexity code for infectious disease physicians.  Discussions around colorectal screening tests that will be allowed for payment and clarifications of who can get the Hepatitis B vaccine and when. 

Webinar Highlights

• Telehealth services
  • what are the new CPT codes and how to utilize them                                                                                                                                                       
• Medicare changes to telehealth services
  • what can and cannot be billed as of today
• Amendments to the paperwork requirements Medicare places on orders for therapy services (Pt, OT, SLP)
• A couple of noteworthy  ICD-10-CM diagnosis codes including a new classification of the severity of eating disorders such as bulimia

Who Should Attend

Coders, Billers, Office Managers, Office Administrators, Credentialing Specialists, Enrollment Specialists, Contracting Specialists, Operations Leadership, Practice Administrators, Medical Practices, Accountable Care Organizations, Medical Societies, Medical Directors, Provider Groups, Management Service Organizations