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Charting the Course: Leading Hospitals Through CMMI’s Seismic Shift  February 19, 11:00 AM PSTWith shifting regulations and increasing technical complexity, hospitals and health systems face constant pressure to maintain compliance. In this session, Vice President of...
From Defense to Offense: Strengthen Your Denials Management Strategy December 3, 2025, 11:00 AM PSTDenials are on the rise, but not all denials are created equal. With mounting payer obstacles, regulatory complexity and staffing constraints, hospitals need smarter...
Price Transparency in 2025: What’s Required, What’s Coming, What to Do Now July 16, 2025, 11:00 AM PST Hospitals are facing mounting expectations around price transparency. But shifting regulations, incomplete guidance, and technical complexity make compliance a...
By Angela Sorbelli, J.D., LL.M, MBA, CHC On April 7, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a Press Release detailing the beginning of the phase-out activity for the temporary emergency waivers that have been in effect since the beginning...
he United States has been in a state of Public Health Emergency (PHE) due to the coronavirus pandemic since January 2020. Section 319 of the Public Health Services (PHS) Act grants the authority to declare and re-evaluate the need for the PHE to the Secretary of Health and Human Services, who reviews the emergency declaration every 90-days and determines whether an extension is warranted.
Overview In a late 2021 legislative session, Congressional activity resulted in a little bit of breathing room for hospitals after the New Year. In a bipartisan vote by Senate late last week, legislation was passed that mitigates nearly 10% Medicare reimbursement cuts...
On November 2, 2021, CMS released the anticipated CY 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule (CMS-1753-FC), finalizing this year’s Medicare payment rates for hospital outpatient and ASC as well including regulatory guidance regarding several high profile policies for hospitals providing outpatient services. CMS evaluated industry feedback to the proposed modifications, including halting the elimination of the Inpatient Only list (IPO), broadening the impact of the Hospital Price Transparency Rule, and other updates.
Additional Funds, Delay in Reporting Requirements, and Audits The Provider Relief Fund (PRF) was established when Congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act to support American families, workers, and healthcare providers in the...
By Jerilyn Morrissey, MD Regardless of who your team reports to on the organization chart, there is no getting around the fact that Utilization Management (UM) is part of the clinical revenue cycle of your organization. Embracing that concept may challenge your...
Let’s talk about denials, a frequent and often unpleasant topic in Utilization Management (UM). One of the core beliefs of most UM teams is that denials are bad, and most of UM teams’ efforts are spent trying to prevent or reduce denials. You may have even purchased...
Charting the Course: Leading Hospitals Through CMMI’s Seismic Shift  February 19, 11:00 AM PSTWith shifting regulations and increasing technical complexity, hospitals and health systems face constant pressure to maintain compliance. In this session, Vice President of...
From Defense to Offense: Strengthen Your Denials Management Strategy December 3, 2025, 11:00 AM PSTDenials are on the rise, but not all denials are created equal. With mounting payer obstacles, regulatory complexity and staffing constraints, hospitals need smarter...
Price Transparency in 2025: What’s Required, What’s Coming, What to Do Now July 16, 2025, 11:00 AM PST Hospitals are facing mounting expectations around price transparency. But shifting regulations, incomplete guidance, and technical complexity make compliance a...
By Angela Sorbelli, J.D., LL.M, MBA, CHC On April 7, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a Press Release detailing the beginning of the phase-out activity for the temporary emergency waivers that have been in effect since the beginning...
he United States has been in a state of Public Health Emergency (PHE) due to the coronavirus pandemic since January 2020. Section 319 of the Public Health Services (PHS) Act grants the authority to declare and re-evaluate the need for the PHE to the Secretary of Health and Human Services, who reviews the emergency declaration every 90-days and determines whether an extension is warranted.
Overview In a late 2021 legislative session, Congressional activity resulted in a little bit of breathing room for hospitals after the New Year. In a bipartisan vote by Senate late last week, legislation was passed that mitigates nearly 10% Medicare reimbursement cuts...
On November 2, 2021, CMS released the anticipated CY 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule (CMS-1753-FC), finalizing this year’s Medicare payment rates for hospital outpatient and ASC as well including regulatory guidance regarding several high profile policies for hospitals providing outpatient services. CMS evaluated industry feedback to the proposed modifications, including halting the elimination of the Inpatient Only list (IPO), broadening the impact of the Hospital Price Transparency Rule, and other updates.
Additional Funds, Delay in Reporting Requirements, and Audits The Provider Relief Fund (PRF) was established when Congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act to support American families, workers, and healthcare providers in the...
By Jerilyn Morrissey, MD Regardless of who your team reports to on the organization chart, there is no getting around the fact that Utilization Management (UM) is part of the clinical revenue cycle of your organization. Embracing that concept may challenge your...
Let’s talk about denials, a frequent and often unpleasant topic in Utilization Management (UM). One of the core beliefs of most UM teams is that denials are bad, and most of UM teams’ efforts are spent trying to prevent or reduce denials. You may have even purchased...
Charting the Course: Leading Hospitals Through CMMI’s Seismic Shift  February 19, 11:00 AM PSTWith shifting regulations and increasing technical complexity, hospitals and health systems face constant pressure to maintain compliance. In this session, Vice President of...
From Defense to Offense: Strengthen Your Denials Management Strategy December 3, 2025, 11:00 AM PSTDenials are on the rise, but not all denials are created equal. With mounting payer obstacles, regulatory complexity and staffing constraints, hospitals need smarter...
Price Transparency in 2025: What’s Required, What’s Coming, What to Do Now July 16, 2025, 11:00 AM PST Hospitals are facing mounting expectations around price transparency. But shifting regulations, incomplete guidance, and technical complexity make compliance a...
