On July 13, the Centers for Medicare & Medicaid Services (CMS) released its annual rule proposing updates to its payment system for physicians in Medicare. For weeks, industry stakeholders had been awaiting the release of this regulation, which is 1,747 pages in length and would update payment policies and programs regarding Medicare payments to physicians and other providers under the Physician Fee Schedule (PFS) on or after January 1, 2022. One of the reasons this rule was so heavily anticipated is because it is one of the first major rules issued by the Biden Administration at a time when many industry stakeholders have spent the past few months wondering whether the change in Presidential Administrations would cause a major shift in CMS’s payment policies. Another reason is because it included critically important policy updates concerning such issues as Medicare payment rates, telehealth services, accountable care organizations (ACOs), and the Merit Based Incentive Payment System (MIPS). In terms of specific policies, the rule proposes to: Following the rule’s release, physician trade and lobbying associations immediately began lobbying to reverse the proposed reduction in the conversion factor. Other policies, including the delayed change in ACO quality measures and delayed implementation of MIPS Value Pathways, are strongly supported by most physician groups. Despite CMS’s positive messaging regarding a permanent expansion of telehealth services, aside from for behavioral health services, this rule does not permanently eliminate the patient geographic and physical site location rules beyond the end of the COVID-19 public health emergency because it would require an act of Congress.