On January 1, 2026, CMS permanently adopted a revised definition of direct supervision, allowing the supervising practitioner to be immediately available through real-time, two-way audio-video technology. The temporary COVID-era extensions are finished; this is now settled policy. But the flexibility is narrower than most practices assume — audio-only does not qualify, and services carrying a 010 or 090 global surgery indicator remain excluded entirely.
Where you practice changes the rules further. A physician working in a hospital-owned outpatient clinic is not governed by the same standard as the practice across the street. Hospital outpatient services follow 42 CFR § 410.27, not the office “incident-to” rule at § 410.26 — and cardiac and pulmonary rehabilitation, extended-duration services, and on-campus versus off-campus status each carry their own requirements. The same service, performed by the same physician, can trigger different supervision obligations and different payment depending on where the room is.
Getting it wrong is expensive: denied claims, recoupment of both professional and facility fees, loss of provider-based status, and False Claims Act exposure. One health system paid $22 million to resolve provider-based billing allegations, and the OIG has an active national audit of incident-to payments. A separate attestation requirement takes effect January 1, 2028.
This practical, compliance-focused session will help you apply the correct supervision standard to every service and setting, document it so it survives audit, and separate what is enforceable today from what remains proposed.
VIRTUAL SUPERVISION IS PERMANENT. THE DOCUMENTATION STANDARD JUST GOT HARDER.
Learn exactly which supervision rule applies to your services and your setting, how on-campus and off-campus status changes your obligations, and what your records must show — long before an auditor asks.
R. Sharma, is a seasoned healthcare professional with over 20 years of clinical and operational experience. As a registered nurse and midwife, his deep clinical foundation spans hands-on patient care, health information management, revenue cycle management, and health technology systems.