Medicare Review - 2026 Update and Operational Reality

Program Description

This comprehensive Medicare review is designed specifically for long-term care providers navigating Medicare and Medicare Advantage in 2026. Building on foundational Medicare principles, this session focuses on what has changed since January 1, 2026 — and what providers are experiencing now in skilled nursing and long-term care settings.

Participants will receive a practical overview of Medicare Part A, Part B, and Medicare Advantage coverage as it applies to skilled nursing facilities, with emphasis on payment rules, documentation expectations, and compliance requirements impacting facilities in early 2026. The session will address PDPM and MDS documentation considerations, consolidated billing, and discharge notice requirements, along with strategies to manage Medicare Advantage denials, prior authorization challenges, and appeal risks.

This course is ideal for both new staff seeking a strong Medicare foundation and experienced professionals looking for a 2026 refresh grounded in real-world operational challenges. Attendees will leave with actionable guidance to strengthen compliance, protect reimbursement, and respond confidently to Medicare and Medicare Advantage pressures.

By the end of this training, participants will be able to:

• Recognize emerging Medicare and Medicare Advantage trends affecting Iowa LTC providers in 2026
• Apply Medicare coverage and payment rules relevant to SNF inpatient and outpatient services
• Identify PDPM and MDS documentation risks that commonly lead to denials or downcoding
• Navigate Medicare Advantage plan requirements and mitigate payment obstacles
• Appropriately apply consolidated billing principles
• Issue required discharge notices, including SNF ABNs and NOMNCs, with confidence

Continuing Education Credit

This program is approved for 3.5 contact hours for:

• NF Administrators
• Nurses
• Social Services

Registration Fees

Members:   $75 per person
Non-Members:    $225 per person

Speaker

Jim Wilkes leads the Data Processing Services team for the Brighton Consulting Group. His expertise is providing consulting and technical reporting services to a large number of Iowa’s providers of skilled nursing and other long-term care services. Throughout his 30+ years in the long-term care sector, he has helped countless facilities establish and maintain Medicare and Medicaid certification. Jim also prepares and consults on Medicare and Medicaid cost reports. Jim is a graduate of Central College in Pella and makes his home in Iowa City.

• Training Hours: 3.50