PYA Webinar Recast

CMS FY 2027 proposed rule changes could significantly affect reimbursement, quality reporting, and operational planning across hospitals and post-acute care settings. In this episode of Healthcare Regulatory Roundup, PYA's Kathy Reep and Carine Leslie break down the most important payment updates, quality program revisions, and compliance considerations providers should evaluate now. The discussion covers inpatient payment updates, Medicare Advantage integration into quality programs, revised reporting timelines, mandatory and proposed quality measures, and operational impacts across skilled nursing, inpatient rehabilitation, psychiatric, long-term acute care, and hospice settings. The presenters also explain where CMS is actively requesting industry feedback and why providers should closely evaluate the financial and staffing implications before final rules are issued. Healthcare executives, finance leaders, reimbursement professionals, compliance officers, and operational teams will gain a clear understanding of the proposed changes and the areas most likely to affect provider organizations in FY 2027.

This episode covers CMS enforcement activity and the downstream impact of Risk Adjustment Data Validation (RADV) audits on healthcare providers participating in Medicare Advantage. PYA experts explain how Medicare Advantage payments flow from CMS to health plans and providers, how risk adjustment drives reimbursement, and why provider documentation plays a critical role in compliance. The discussion also outlines current audit trends, documentation requirements, and practical strategies providers can use to reduce risk and respond to increasing regulatory scrutiny.

This episode covers the impact of the One Big Beautiful Bill Act (OBBBA) on Medicare DSH and the 340B drug pricing program. PYA presenters explain how new Medicaid eligibility requirements may affect hospital reimbursement, patient mix, and program eligibility, and outline strategies for accurately capturing Medicaid eligible days. The discussion also reviews recent 340B developments, including legal rulings, the status of the rebate model, CMS drug pricing surveys, and growing state-level legislative activity. Hospitals will gain a clearer understanding of current risks, operational considerations, and areas requiring proactive monitoring.

How hospitals can prepare for financial risk under the CMS TEAM model by turning claims data into actionable performance insights. This session explains how to quantify downside exposure, identify variation across episodes, and use dashboards and governance structures to drive measurable improvement.

This episode outlines the top 10 healthcare compliance risk areas managers need to know in 2026. PYA compliance leaders, Shannon Sumner, Miriam Murray, and Katie Croswell, discuss vendor oversight, cybersecurity and data breaches, artificial intelligence governance, digital transformation, healthcare real estate, EMTALA compliance, exclusion screenings, and reimbursement pressures. The session emphasizes practical risk mitigation strategies, including third-party risk management life cycles, AI inventory and governance structures, access monitoring, documentation standards, and continuous auditing. Listeners will gain a structured view of emerging and persistent compliance risks affecting healthcare organizations. 

This episode examines how healthcare organizations can mitigate compliance and financial risk while conducting revenue integrity audits. PYA Principal Valerie Rock and Manager Kimberly Campbell walk through the auditing and monitoring cycle, with a focus on defensible sampling, documentation, and interpretation of results. The discussion covers: Probe audits versus statistically valid random samples Use of data analytics Understanding claims and financial error rates Navigating the Medicare 60-day rule when overpayments are identified Corrective actions Root cause analysis Internal controls needed to support sustainable compliance after an audit

This episode reviews new proposed rules, payment models, and regulatory guidance affecting healthcare organizations in early 2026. PYA Principals Martie Ross and Kathy Reep break down recent legislative activity, Medicare and Medicaid policy updates, and regulatory changes providers should be tracking as the year begins. Topics include: Medicare telehealth extensions Healthcare extenders Medicaid work requirements Medicare Advantage oversight 340B drug program developments Price transparency rules Interoperability initiatives Emerging alternative payment models The discussion highlights how these changes may affect reimbursement, compliance, and operational planning.

This episode examines key policy, payment, and program changes shaping rural healthcare in 2026. PYA Principals Martie Ross and Kathy Reep discuss major federal initiatives affecting rural providers, including the Rural Health Transformation Program, Medicare telehealth policy, and Medicaid developments. The session also addresses Medicare Advantage oversight, 340B drug program compliance, price transparency requirements, and emerging alternative payment models. Throughout the discussion, the presenters highlight practical implications for rural hospitals and health systems as they plan for regulatory and reimbursement changes in the year ahead. Presented by Martie Ross and Kathy Reep on January 15, 2026. Key topics include: The Rural Health Transformation Program Medicare telehealth updates Medicare Advantage reforms 340B drug program requirements Hospital price transparency Evolving alternative payment models The session provides context and planning considerations for rural organizations navigating a complex regulatory environment.

This episode of PYA's Healthcare Regulatory Roundup continues a two-part discussion on the 2026 Medicare Physician Fee Schedule Final Rule, with a focus on telehealth, global payment reforms, and skin substitutes. The conversation walks through what stays in place for telehealth, including face-to-face visit requirements, and highlights new codes related to telebehavioral health and global surgery indicators. The episode also examines changes to global payment methodologies and post-operative care valuation, along with a major shift in how skin substitutes will be paid under Medicare. Additional updates include new care management codes for behavioral health integration and remote monitoring, as well as the extension of the Medicare Diabetes Prevention Program's virtual option through 2029. Presented by Valerie Rock and Martie Ross on December 10, 2025. Topics Covered: Telehealth Global Payments Skin Substitutes Care Management Prevention and Wellness

This episode of PYA's Healthcare Regulatory Roundup examines the 2026 Medicare Physician Fee Schedule Final Rule and its impact on physician reimbursement, payment calculations, and quality reporting. The discussion covers updates to the conversion factor under MACRA, budget neutrality adjustments, new efficiency adjustments affecting work RVUs, and revisions to the practice expense methodology.The presenters also review finalized changes to MIPS quality, cost, and interoperability requirements, along with the introduction of the mandatory Ambulatory Specialty Model beginning in 2027. The episode concludes with considerations for physician practices and healthcare organizations as they evaluate compliance obligations and reimbursement impacts under the final rule. Presented by Martie Ross, Sarah Bowman, and Lori Foley on December 3, 2025. Topics Covered: 2026 Payment Rate/Conversion Factor Efficiency Adjustment Practice Expense Methodology Ambulatory Specialty Model (new mandatory alternative payment model) Merit-Based Incentive Payment System (MIPS) Medicare Shared Savings Program (MSSP)

The Centers for Medicare & Medicaid Services (CMS) published the 2026 Hospital Outpatient Prospective Payment System (OPPS) final rule. In this webinar, Martie Ross and Kathy Reep discussed key provisions of the 2026 Hospital OPPS final rule and related developments. Attendees will gain knowledge from these learning objectives:  Details of 2026 OPPS final rule Developments in care for end-stage renal disease Status update on home health final rules Information about payment updates Actions on site neutrality Changes to the 340B Drug Program Aspects of the inpatient-only list Updates about price transparency This webinar is part of PYA's twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. For more than 40 years, PYA has been committed to regulatory compliance and helping healthcare organizations create attainable compliance programs while mitigating risks.  

A strong compliance program begins with a clear understanding of organizational risks. This webinar guides you through the purpose, process, and practical application of conducting a compliance risk assessment—and how to transform the findings into a robust annual framework. During this webinar, PYA Principals Shannon Sumner and Rhonda Buckholtz explained the importance of effective risk assessments and how to incorporate them into your annual plan. Shannon and Rhonda addressed the following objectives: Defining the role of risk assessments. Identifying common risk areas. Applying a structured methodology. Demonstrating documentation practices for key stakeholders. Incorporating ongoing monitoring and feedback loops to update risk assessments. RELATED LINKS: U.S. Department of Justice Criminal Division Evaluation of Corporate Compliance Programs OIG General Compliance Program Guidance COSO ERM Framework   *This recording was updated on February 11, 2026 to fix an audio issue. The edit is technical only and does not impact the content of the webinar.

On October 1 — the first day of the new federal fiscal year — PYA's Martie Ross and Kathy Reep provided a timely update on federal policy developments shaping healthcare. They reviewed the latest actions from Congress and federal agencies, focusing on issues that have a direct impact on providers and healthcare organizations. Key topics for discussion included: Federal FY 2026 discretionary spending and government shutdown risk Calendar Year 2026 Medicare sequestration status Rural Health Transformation Program funding opportunity and deadlines Congressional hearings on tax-exempt hospitals New visa application fees and implications for healthcare

The Food and Drug Administration (FDA) has issued draft guidance to establish a comprehensive regulatory framework for artificial intelligence and machine learning (AI/ML) in medical devices. As AI becomes embedded in connected health technologies, the cybersecurity risks associated with such devices are growing exponentially. This webinar explores how the FDA's lifecycle-based approach to AI regulation intersects with cybersecurity for connected medical devices. Principals Barry Mathis and John Cross provided an overview of the FDA's draft guidance on AI/ML-enabled medical devices and discussed how cybersecurity risks in the Internet of Medical Things (IoMT) can be addressed. Attendees gained knowledge through these learning objectives: Learn about AI and its use cases, including use in embedded medical devices Understand the FDA's Total Product Lifecycle approach to regulating AI/ML-enabled medical devices Identify cybersecurity risks unique to IoMT devices Analyze a real-world case study of an AI-enabled insulin pump and its cybersecurity implications Apply compliance strategies, including Secure Product Development Frameworks and Software Bill of Materials, to meet FDA expectations This webinar is part of PYA's twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. PYA is dedicated to helping healthcare organizations understand regulatory requirements and prepare for and respond to cybersecurity threats.

On July 31, the Centers for Medicare & Medicaid Services (CMS) issued both the 2026 Medicare Inpatient Prospective Payment System (PPS) and the Skilled Nursing Facility (SNF) PPS final rules. PYA's Martie Ross and Kathy Reep discussed several key provisions, including: Payment rate increases for inpatient acute facilities, long-term care hospitals, and skilled nursing facilities Revisions to the mandatory Transforming Episode Accountability Model (TEAM) Changes to the wage index and related policies Updates to the Hospital Inpatient Quality Reporting program Changes to the Hospital Readmissions and Hospital-Acquired Conditions Reduction programs, as well as the Hospital Value-Based Purchasing program Revisions to the Promoting Interoperability program Martie and Kathy also addressed key provisions in the 2026 Inpatient Rehabilitation Facility and Inpatient Psychiatric Facility final rules issued by CMS on August 1. 100th Webinar! On August 27, PYA's twice-monthly Healthcare Regulatory Roundup (HCRR) celebrated its 100th webinar in the series. Beginning with the first webinar in 2021, PYA experts have reliably provided practical insights on the latest industry regulatory developments. Thank you for your support of this sentinel series. PYA is dedicated to helping healthcare organizations understand and comply with legislative and regulatory impacts. Contact Martie, Kathy, or any of our experts for assistance.

On July 14, CMS released the 2026 Medicare Physician Fee Schedule Proposed Rule (MPFS). The proposed rule includes several significant policy changes that could impact physicians for years to come. During this two-part webinar series, PYA experts went deep into these changes to help you understand and prepare for what's coming next. Presented August 13, 2025, by Valerie Rock and Martie Ross Topics: Telehealth Global Payments Skin Substitutes Care Management Prevention and Wellness The popular twice-monthly PYA Healthcare Regulatory Roundup provides practical insights on the latest industry regulatory developments. PYA helps healthcare leaders with legislative and regulatory impacts and matters involving compliance, valuation, strategy, and transactions.

On July 14, CMS released the 2026 Medicare Physician Fee Schedule Proposed Rule (MPFS). The proposed rule includes several significant policy changes that could impact physicians for years to come. During this two-part webinar series, PYA experts will go deep into these changes to help you understand and prepare for what's coming next. Presented July 30, 2025, by Martie Ross, Sarah Bowman, and Lori Foley Topics Covered: 2026 Payment Rate/Conversion Factor Efficiency Adjustment Practice Expense Methodology Ambulatory Specialty Model (new mandatory alternative payment model) Merit-Based Incentive Payment System (MIPS) Medicare Shared Savings Program (MSSP)

Compensation is no longer just a financial tool—it's a powerful strategy to shape behavior, align priorities, and drive performance. Thoughtful compensation design can foster a culture of quality, boost collaboration and accountability, and enhance patient and provider satisfaction. During this webinar, PYA Principal Angie Caldwell and Manager Ericka Dickinson discussed why strategically aligned compensation models are so important in today's healthcare landscape and provided ways to align your provider compensation models to your organization's strategic goals. Attendees gained knowledge from these learning objectives: Learn ways your organization may be impacted by a strategically aligned compensation model Understand how to enhance recruiting efforts Gain improvement in retention and satisfaction rates Assess methods to operationalize alignment   Learn more: Benefits of strategically aligned compensation models PYA's Compensation Valuation Planning and Design For more than 40 years, PYA has helped healthcare leaders with provider compensation design, fair market value, commercial reasonableness, and other matters related to compensation valuation, compliance, strategy, and integration. Presented: July 22, 2025.

The One Big Beautiful Bill Act (OBBBA) is now law, and healthcare providers must quickly assess its implications. In this session, PYA's Martie Ross and Kathy Reep examined OBBBA's sweeping changes to Medicare, Medicaid, and the ACA Marketplace. Martie and Kathy also addressed new proposed rules from the Centers for Medicare & Medicaid Services (CMS), including the 2026 hospital outpatient, home health, and end-stage renal disease payment rules. Presented on: July 16, 2025.

Twice each year, PYA's Center for Rural Health Advancement presents a deep dive into the most challenging regulatory and reimbursement issues facing rural health providers and the communities they serve. During this 90-minute webinar, PYA's Martie Ross and Kathy Reep provided practical insights and advice for rural health leaders on the following topics: Impact of One Big Beautiful Bill on rural providers Impact of HHS restructuring on rural providers Key provisions of proposed 2026 Medicare payment rules  Current telehealth policy update Recent regulatory developments, including price transparency, HIPAA, EMTALA, Conditions of Participation, and more Federal enforcement activity What rural leaders need to know about Medicare Advantage This webinar is part of PYA's Let's Get Rural series, which reflects PYA's commitment to helping rural health providers preserve access to high-quality services for their communities. Check out all of PYA's Let's Get Rural webinars. PYA experts are committed to assisting with the unique needs of rural healthcare, including regulatory impacts, reimbursement opportunities, and any matter involving compliance, valuation, strategy, and transactions.

During this webinar, PYA's Barry Mathis explored the critical aspects of healthcare data breaches, focusing on understanding the immediate impacts, effective incident response steps, legal and regulatory requirements, communication strategies, long-term mitigation measures, and lessons learned from real-world case studies. The session aims to equip healthcare professionals with the tools and takeaways necessary to respond to data breaches effectively and mitigate future risks: An understanding of the multifaceted consequences of a data breach Practical steps for containment, eradication, and recovery Knowledge of HIPAA compliance and reporting obligations Ability to communicate transparently with patients, stakeholders, and the public Attendees learned from these educational objectives: Understand the immediate impact of a data breach, including financial, reputational, and operational consequences Learn effective incident response steps, including containment, eradication, and recovery Comply with legal and regulatory requirements, such as HIPAA compliance and timely reporting Develop communication strategies to notify affected parties and manage public perception Presented: Thursday, June 19, 2025

As we near our nation's 249th birthday, issues continue to heat up in Washington, D.C. During this one-hour webinar, PYA's Martie Ross and Kathy Reep addressed the most recent legislative, regulatory, and enforcement activities at the federal level: Updates on the One Big Beautiful Bill Act President's FY 2026 Budget Proposal Medicaid Provider Taxes and State-Directed Payments CMS Guidance: Price Transparency, EMTALA, Treatment for Gender Dysphoria Medicare Advantage Audits This webinar is part of PYA's twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. If you would like assistance with legislative or regulatory impacts or any matter involving compliance, valuation, or strategy and transactions, our executives are happy to assist. This webinar was presented Wednesday, June 25, 2025.

Tax planning becomes exceptionally challenging during non-consecutive presidential administrations because each administration may pursue vastly different fiscal philosophies, often reversing or modifying prior tax laws before they fully mature. Given that most tax legislation has built-in sunsets, phased-in provisions, or long-term implications, the lack of continuity in executive leadership can undermine stability and predictability. This political pendulum creates an environment of uncertainty for individuals and businesses alike, making it difficult to design long-term strategies with confidence. During this session, Joe, Patrick, and Victoria explained any remaining sunsetting provisions from the 2017 Tax Cuts and Jobs Act, provided insights into how changing tax laws, policy reversals, and legislative uncertainty impact planning strategies for individuals and businesses, and discussed legislation being considered by the Trump administration ("One Big Beautiful Bill"). By understanding the intersection of the budget reconciliation process and political cycles, you and your team will be better equipped to act in the most tax-efficient manner and adapt to evolving regulatory landscapes. Attendees learned from these key session objectives: • Identified how changes in presidential administrations impact long-term tax policy and planning • Analyzed the effects of temporary tax provisions and sunset clauses on strategic decision-making • Explained the role of budget reconciliation in shaping tax legislation • Explored various provisions of pending tax legislation • Evaluated the risks and uncertainties businesses and individuals face within politically volatile environments • Developed adaptable tax strategies that account for legislative reversals and partisan shifts

Third-Party Risk Management (TPRM) helps healthcare organizations reduce cybersecurity, compliance, and privacy risks posed by vendors and service providers. This webinar explains key TPRM program elements—including risk assessment, due diligence, and governance—and how they address HIPAA, FDA, and other regulatory requirements. Cyberattacks, ransomware, supply chain shortages, privacy breaches, and the resulting regulatory focus, fines, and penalties have all demonstrated the critical importance of a robust Third-Party Risk Management Program (TPMP) for healthcare entities of all sizes. During this session, Lori Foley discussed the key elements and importance of an integrated Third-Party Risk Management (TPRM) program, with an emphasis on the regulatory and compliance landscape. Specifically, attendees learned from these key points: Importance of TPRM in healthcare Brief overview of recent incidents or regulatory focus areas Definition and types of third parties (e.g., IT vendors, medical device manufacturers, outsourced service providers) Regulatory and compliance requirements pertaining to third-party vendors (e.g., BAAs, HIPAA, FDA) Core elements of a TPRM program lifecycle (inventory, risk assessment, due diligence, contracting, and ongoing monitoring) Coordination of parties in identification and mitigation of risks (e.g., internal audit, compliance, legal, quality, risk management, IT) Recommendations for appropriate governance oversight This was presented on Wednesday, June 18, 2025 12:30 pm – 1:30 pm E.T.

Keeping up with the flurry of executive orders, regulatory changes, new tariffs, agency downsizings, and legislative proposals can feel like a full-time job. During this session, PYA's Martie Ross and Matt Stuart discussed how healthcare has fared during the first 150 days of the Trump Administration. Specifically, Martie and Matt addressed: Make America Healthy Again initiatives Updates to the Medicare and Medicaid programs Increases in government enforcement activities Changes to rulemaking processes Impact of tariffs and other executive actions Attendees gained knowledge from these learning objectives: Summarized key executive actions impacting healthcare providers Discussed current status of legislative budgeting and appropriations process impacting healthcare Appreciated additional changes on the horizon Identified priorities to manage the impact of rapidly changing regulatory environment Presented on: Wednesday, June 18, 2025 11:00 am – 12:00 pm E.T.

Like many areas in healthcare, the 340B drug pricing program is changing. Feedback from PYA's recent webinars indicates that healthcare professionals need the basics about the 340B drug pricing program, updates about what's changing, and tips on how to stay in compliance. PYA's Sarah Bowman explained how to learn and prepare for what's coming, covering this key information: What to know about the 340B program, including its history and key compliance requirements What to watch for to avoid common compliance pitfalls What to do now to respond to recent events and maintain compliance in today's challenging environment VIEW RESENTATION SLIDES This webinar is part of PYA's twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. If you would like assistance with 340B program compliance or legislative or regulatory impacts, PYA is happy to help.

One Big Beautiful Bill Act – Update In the early morning hours of May 22 – the day after we presented One Big, Beautiful Webinar, the House of Representatives approved its budget reconciliation bill, known as the One Big Beautiful Bill Act (OBBBA), by a vote of 215-214. The path to final passage was cleared by a 42-page amendment to the version of the bill previously approved by the House Budget Committee. Here are the key healthcare-related changes: States must comply with the new Medicaid work requirements by December 31, 2026 (2 years earlier than originally proposed). HHS is required to publish guidance (as opposed to regulations, which would require notice and comment rulemaking) regarding implementation of work requirements no later than December 31, 2025. Several provisions that afforded states some flexibility in implementing the Medicaid work requirements have been deleted. For states that have not expanded Medicaid, the cap on provider rates for state-directed payments will be 110% of Medicare rates (vs.100% for other states). The prohibition on the use of Medicaid funds for gender transition procedures is no longer limited to minors ACA Marketplace insurers will again receive cost-sharing reduction payments as reimbursement for reduced deductibles, copayments, and/or coinsurance for low-income enrollees. In other late-breaking news, the Congressional Budget Office released its analysis of the potential Statutory Pay-As-You-Go (PAYGO) effects of OBBBA. According to CBO, OBBBA will increase the deficit by an average of $230 billion over the next 10 years. "Without enactment of subsequent legislation that would offset the deficit increase, waive the recordation of the bill's effects on the scorecard, or otherwise mitigate or eliminate the statutory requirement," Medicare payments would be reduced by 4% beginning in 2026 and continuing through 2034 under PAYGO's automatic deficit reduction provisions. That's an estimated $45 billion reduction in payments to providers, Medicare Advantage plans, and stand-alone prescription drug plans for next year. Assuming OBBBA is enacted, Congress could act before the end of the year to block sequestration cuts as it has done in the past (e.g., with the 2017 Tax Cuts and Jobs Act and the 2021 American Rescue Plan). However, unlike the reconciliation bill, it will require 60 votes in the Senate to exclude OBBBA's deficit increase from the PAYGO scorecard. Keep in mind the party is just getting started. The Senate will begin consideration of OBBBA when it returns from its Memorial Day holiday on June 2.  Majority Leader Thune said on May 21 that the Senate "will have its imprint" on OBBBA. There are several Republican senators on record opposing cuts to the Medicaid program. And wouldn't it be nice if Congress finally made the Medicare telehealth waivers permanent as part of the reconciliation bill?  The Majority Leader hopes to have the Senate complete its work before the 4th of July holiday. These days, it's nearly a full-time job keeping up with developments in D.C., much less figuring out how to respond to the changes. During this one-hour webinar, PYA's Martie Ross and Kathy Reep brought some clarity to the chaos by addressing these topics: Status of Budget Reconciliation and FY 2026 Appropriations   Department of Health & Human Services Reorganization New Medicare and Medicaid Enforcement Activities View Presentation Slides This webinar is part of PYA's twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. If you would like assistance with legislative or regulatory impacts or any matter involving compliance, valuation, or strategy and transactions, our executives are happy to assist.

It's spring, and deregulation is in the air! During this one-hour webinar, PYA's Martie Ross and Kathy Reep discussed the impact of the April 9 Presidential Memorandum Directing the Repeal of Unlawful Regulations. The memorandum instructs federal agencies to repeal any regulation "that clearly exceeds the agency's statutory authority or is otherwise unlawful" and to proceed "without notice and comment, where doing so is consistent with the 'good cause' exception in the Administrative Procedure Act." The webinar also addressed the Request for Information (RFI) included in the 2026 Inpatient Prospective Payment System proposed rule soliciting public feedback on potential changes to Medicare regulations. Examples of questions CMS would like input on include: Are there documentation or reporting requirements within the Medicare program that are overly complex or redundant? How can Medicare better align its requirements with best practices and industry standards? Are there existing regulatory requirements that could be waived, modified, or streamlined to reduce administrative burdens? Martie and Kathy highlighted regulatory requirements that may meet these criteria and discuss how to respond to the RFI. They also addressed any late-breaking news from DC on the ongoing budget reconciliation process. This webinar is part of PYA's twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. If you would like assistance with legislative or regulatory impacts or any matter involving compliance, valuation, or strategy and transactions, our executives are happy to assist.

On Friday afternoon, April 11, the Centers for Medicare & Medicaid Services (CMS) released the proposed 2026 Medicare payment rules. These proposed rules cover: Hospital inpatient services Skilled nursing facilities Inpatient psychiatric and rehabilitation facilities Hospices During this webinar, PYA's Martie Ross and Kathy Reep discussed: Key provisions of the proposed 2026 Medicare payment rules The 2026 Medicare Advantage final rule and rate announcement released earlier this month The latest developments in Washington, including: President Trump's deregulation directive The ongoing budget reconciliation process PRESENTATION SLIDES This webinar is part of PYA's twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. If you would like assistance with legislative or regulatory impacts or any matter involving compliance, valuation, or strategy and transactions, our executives are happy to assist.

It's challenging to keep up with everything happening in Washington these days. Given the potential impact on our healthcare system, one cannot afford to fall behind. During this webinar, PYA's Martie Ross and Kathy Reep summarized the latest developments coming from Washington: Proposed cuts to federal healthcare programs Impact of Executive Orders Changes to rulemaking processes PRESENTATION SLIDES This webinar is part of PYA's twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. If you would like assistance with legislative or regulatory impacts or any matter involving compliance, valuation, or strategy and transactions, our executives are happy to assist.

The likelihood Congress will adopt site-neutral payment reforms seems to be increasing daily. Hospitals need to understand the full impact of such reforms and prepare contingency plans in case of significant cuts to reimbursement. During this webinar, presented on March 5, 2025, PYA's Kathy Reep and Martie Ross addressed key aspects of the potential reforms: Location, Location, Location:Variation in Medicare reimbursement based on place of service   Ugly, Uglier, Ugliest:  Proposed payment reforms   Big, Bigger, Biggest: Quantifying potential lost revenue from site-neutral payment reforms   Survival of the Fittest:  Strategies for minimizing and tactics for dealing with losses   Telling Your Story: Helping your community understand impacts of payment reforms

In January 2025, the U.S. Department of Health and Human Services proposed pivotal updates to the HIPAA Security Rule aimed at enhancing cybersecurity measures for electronic protected health information (ePHI). During this webinar, we took a comprehensive look at the proposed HIPAA Security Rule, delving into the specifics of what changes are being suggested and how they could impact various stakeholders. The webinar took place February 26, 2025. PYA's Barry Mathis and Erin Walker offered a detailed understanding of the rule's implications, the motivations behind its revision, and the potential effects on healthcare providers, insurers, and patients. Participants learned from the following objectives: Understanding the Proposed Changes:Identified and explained the key modifications suggested in the HIPAA Security Rule Implications for Compliance:Explored how these changes would alter current compliance requirements and how organizations can adhere to the new rule Impact Assessment:Assessed the potential consequences of the proposed rule on privacy, security, and data management within the healthcare sector Preparation Strategies:Discussed strategies for healthcare organizations to prepare for and implement the proposed changes effectively

Over the last several years, Medicare reimbursement for virtual care, including care management and remote monitoring services, has expanded. PYA Principals Lori Foley and Martie Ross presented a webinar, "Providing and Billing Medicare for Care Management and Remote Monitoring Services," on February 12, 2025. During this one-hour webinar, Foley and Ross discussed: Use of care management and remote monitoring services and impact on total cost of care Medicare billing rules for care management and remote monitoring services: Chronic care management Complex chronic care management Principal care management Advanced primary care management Remote physiologic monitoring Remote therapeutic monitoring Navigation of ambiguities in Medicare billing rules   Lessons learned from launching care management and remote monitoring programs

This presentation covered the key antitrust issues that arise in mergers and acquisitions involving healthcare providers, including hot issues in federal and state antitrust enforcement, practical tips for staying compliant in due diligence and integration planning, and major changes to the requirements for reporting transactions under the Hart-Scott-Rodino Act. Learning objectives for this session included the following: Understanding key antitrust requirements and risks that arise in healthcare mergers and acquisitions Understanding recent reforms to the federal Merger Guidelines Unpacking key changes to the rules for reporting transactions under the Hart-Scott-Rodino Act and what they mean for the healthcare sector Addressing state regulatory requirements and their impact on healthcare mergers and acquisitions Addressing potential antitrust enforcement trends and priorities for the second Trump administration On January 23-24, PYA and Foley & Lardner LLP presented the seventh annual Let's Talk Compliance virtual conference. The event was moderated by Foley Health Care Partner Jana Kolarik and PYA Principal Angie Caldwell. Panelists included attorneys from Foley's Health Care & Life Sciences Sector as well as PYA's healthcare consulting, compliance, and cybersecurity experts. Each day featured two sessions that covered relevant and trending topics in healthcare and life sciences compliance.

The end of Chevron deference and President Trump's reelection mean federal agencies like the Centers for Medicare & Medicaid Services, Health Resources and Services Administration, and the Food and Drug Administration will operate under fundamentally different rules than in the past. This presentation explained the changes and identified what organizations need to know. Learning objectives for this session included the following: Provided key background on the Chevron doctrine, which required courts to defer to agencies' interpretations of statutes, and the Supreme Court's overturning of it in Loper Bright Identified important changes resulting from Chevron's end and the election of President Trump, including more cautious rulemaking, more frequent challenges to agency actions, and more restrictions on subregulatory guidance Identified risks and opportunities for healthcare companies that are subject to agencies' rules, actions, and guidance On January 23-24, PYA and Foley & Lardner LLP presented the seventh annual Let's Talk Compliance virtual conference. The event was moderated by Foley Health Care Partner Jana Kolarik and PYA Principal Angie Caldwell. Panelists included attorneys from Foley's Health Care & Life Sciences Sector as well as PYA's healthcare consulting, compliance, and cybersecurity experts. Each day featured two sessions that covered relevant and trending topics in healthcare and life sciences compliance.

The Transforming Episode Accountability Model (TEAM) is less than a year away. Beginning Jan. 1, 2026, selected hospitals will be subject to this new Medicare mandatory episodic payment model for specified surgical episodes of care. On January 30, PYA's Martie Ross, Kathy Reep, Jason Hardin, Lee Ann Odom, and Angie Caldwell introduced PYA's TEAM playbook, highlighting what your organization can do now to ensure future success: Understand TEAM rules   Educate leadership, management, and medical staff Use currently available data to identify opportunities Pursue performance transformation to reduce episodic costs Enter into TEAM-compliant collaborator sharing arrangements with physicians and post-acute providers For providers not directly participating in TEAM, the PYA experts discussed broader market impacts of this new program, including changing referral patterns, patient preferences, and commercial payer opportunities.

This presentation covered updates and strategies for healthcare cybersecurity defenses and incident response, Health and Human Services' (HHS) continued enforcement of patient rights in accessing their own health information, and HIPAA's amendments to protect reproductive healthcare information. Learning objectives for this session included the following: Discussed trends in healthcare cybersecurity, including expected updates to the HIPAA Security Rule, HHS' Security Risk Analysis enforcement initiative, and recent HHS ransomware settlements Provided a refresher on HIPAA's right for individuals to access their own information, in light of HHS' continued HIPAA Right of Access enforcement initiative Discussed the status of HIPAA's recent amendments to provide additional protections for reproductive healthcare information under the incoming Trump administration Shared effective strategies for cyber event response, focusing on containment, mitigation, and recovery, with lessons learned from recent cyber incidents in healthcare Explored the role of artificial intelligence in enhancing cybersecurity defenses, including its applications in threat detection, anomaly analysis, and predictive security measures Explained how to manage cyber risks with third-party vendors, emphasizing the importance of vendor risk assessments, contract provisions, and ongoing monitoring to ensure compliance and safeguard sensitive information On January 23-24, PYA and Foley & Lardner LLP presented the seventh annual Let's Talk Compliance virtual conference. The event was moderated by Foley Health Care Partner Jana Kolarik and PYA Principal Angie Caldwell. Panelists included attorneys from Foley's Health Care & Life Sciences Sector as well as PYA's healthcare consulting, compliance, and cybersecurity experts. Each day featured two sessions that covered relevant and trending topics in healthcare and life sciences compliance.

As in the lyrics of "Auld Lang Syne," the beginning of a new year leads us to reflect nostalgically. For compliance experts, that means considering what the compliance industry learned from implementing the new and refreshed Office of Inspector General (OIG) General Compliance Program Guidance (GCPG) in 2024 while we set the stage for 2025. Learning objectives for this session included the following: Discussed GCPG implementation best practices identified from serving clients in 2024 Shared key concepts with which clients are still struggling and steps they are taking to comply with the GCPG's expectations Provided an overview of the latest industry segment-specific guidance for Skilled Nursing Facilities Summarized significant settlements and cases that pressure-tested organizations' compliance programs in 2024 Let's Talk Compliance: Trends Affecting the Health Care & Life Sciences Sector On January 23-24, PYA and Foley & Lardner LLP presented the seventh annual Let's Talk Compliance virtual conference. The event was moderated by Foley Health Care Partner Jana Kolarik and PYA Principal Angie Caldwell. Panelists included attorneys from Foley's Health Care & Life Sciences Sector as well as PYA's healthcare consulting, compliance, and cybersecurity experts. Each day featured two sessions that covered relevant and trending topics in healthcare and life sciences compliance.

On Dec. 21, 2024, President Biden signed the American Relief Act, 2025 (ARA), into law, narrowly avoiding a federal government shutdown. Unlike the more comprehensive bill defeated in the House of Representatives two days earlier after President-elect Trump raised objections, the ARA is a temporary solution to keep the federal government operating through the end of March. On Jan. 15, 2025, PYA's Martie Ross and Kathy Reep discussed the new law's impact, both by what's included and what's not. Ross and Reep prognosticated what will happen in the first months of the Trump administration to address critical outstanding issues such as: Medicare telehealth coverage Medicare physician pay cut Price transparency Site-neutral payments Medicaid DSH payments Hospital-at-home demonstration project Also, Martie and Kathy discussed two proposed rules released in December: the Contract Year 2026 Medicare Advantage and Part D Proposed Rule and the proposed updates to the HIPAA Security Rule. To wrap things up, they also discussed the impact of the January 7, 2025, final rule from the Consumer Financial Protection Bureau prohibiting creditors from considering medical debt in credit eligibility decisions. This webinar is part of PYA's twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. If you would like assistance with legislative or regulatory impacts or any matter involving compliance, valuation, or strategy and transactions, our executives are happy to assist.

Twice each year, PYA's Center for Rural Health Advancement presents a deep dive into the most challenging regulatory and reimbursement issues facing rural health providers and the communities they serve.  Our second "Let's Get Rural" webinar took place December 5, 2024. During this webinar, PYA's Martie Ross and Kathy Reep joined Realty Trust Group's Colton Hager to provide practical insights and advice for rural health leaders on the following topics: Provisions in 2025 Medicare Physician Fee Schedule Final Rule impacting rural health clinics   Telehealth update Rural Emergency Hospital program update Respiratory disease reporting requirements Maternal health Conditions of Participation New anti-discrimination regulations Impact of new TEAM Payment Model on rural providers Changes to HIPAA Privacy Rule Price transparency update Medicare co-insurance for critical access hospitals Impact of Supreme Court's Loper Bright decision This webinar is part of PYA's Let's Get Rural series, which reflects PYA's commitment to helping rural health providers preserve access to high-quality services for their communities. Learn more: Check out the first Let's Get Rural webinar of 2024, presented on June 13: "Managing Regulatory and Reimbursement Challenges." Learn more about PYA's Center for Rural Health Advancement. If you would like assistance with the unique needs of rural healthcare, including regulatory impacts, reimbursement opportunities, or any matter involving compliance, valuation, or strategy and transactions, our executives would be happy to assist.   Attendees of the live webinar were eligible for 1.5 CPE credits in Specialized Knowledge.

On December 4, 2024, Kimberly Campbell, Katie Croswell, Carine Leslie, Brian Raabe, and Valerie Rock went deeper into the final rule to address the following:    Global surgery payment accuracy Evaluation & management services (including HCPCS G2211) New reimbursement for preventive services Digital therapeutics for behavioral health Supervision of outpatient therapy services Opioid treatment programs Skin substitutes On November 13, PYA presented "2025 Hospital Outpatient Prospective Payment System Final Rule." in which Martie Ross and Kathy Reep discussed key provisions of the 2025 Hospital OPPS Final Rule and related developments. The four webinars are part of PYA's twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. If you would like assistance with legislative or regulatory impacts or any matter involving compliance, valuation, or strategy and transactions, our executives are happy to assist.

On November 20, 2024, Miriam Murray, Valerie Rock, and Martie Ross covered the following topics from the final rule:  2025 payment rate reductioc Deadline for reporting overpayments Advanced primary care management payments Telehealth Rural health clinics and federally qualified health centers The four webinars are part of PYA's twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. If you would like assistance with legislative or regulatory impacts or any matter involving compliance, valuation, or strategy and transactions, our executives are happy to assist.

On November 1, 2024, the Centers for Medicare & Medicaid Services published the 2025 Hospital Outpatient Prospective Payment System (OPPS) Final Rule. During this webinar, PYA's Martie Ross and Kathy Reep discussed key provisions of the 2025 Hospital OPPS Final Rule and related developments, including the following: Updated Hospital OPPS Payment Rates Updated Ambulatory Surgical Center Payment Rates Hospital OPPS and ASC Quality Programs Maternal Health Conditions of Participation New Appeals Process Relating to Observation Stays The webinar took place on November 13, 2024. This webinar is part of PYA's twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. If you would like assistance with legislative or regulatory impacts or any matter involving compliance, valuation, or strategy and transactions, our executives are happy to assist.

The 340B environment has continued to evolve, and this year has been particularly busy as the drug pricing program is targeted and challenged. Covered Entities (CEs) and other professionals are invited to join us for an update on federal and state regulatory and legislative activity along with a discussion on the administrative dispute resolution process, Medicare Advantage payer litigation, and how CEs can continue to maintain a compliant 340B program despite these challenges.   Attendees learned more about the latest challenges to the 340B drug pricing program and how you can maintain a compliant program during this webinar which took place on October 23, 2024. During this webinar, PYA's Sarah Bowman discussed key updates to 340B as attendees learned from these objectives: Discussed key state and federal legislative activity Provided a regulatory update Reviewed the status of drug manufacturer restrictions and the Administrative Dispute Resolution process Described Medicare Advantage payer litigation activity Discussed HRSA Audit activity and Covered Entity best practices This webinar was part of PYA's twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. If you would like assistance with legislative or regulatory impacts or any matter involving compliance, valuation, or strategy and transactions, our executives are happy to assist.

Covered entities and business associates must comply with the new HIPAA Privacy Rule requirements regarding reproductive healthcare by Dec. 23, 2024. Over the summer, new anti-discrimination requirements for healthcare providers detailed in new regulations promulgated under Section 1557 of the Affordable Care Act and Section 504 of the Rehabilitation Act of 1973 took effect.  PYA's Karin Anderson and Martie Ross detailed what providers need to do now to comply with these new rules during this webinar which took place on October 9, 2024. This webinar is part of PYA's twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. If you would like assistance with legislative or regulatory impacts or any matter involving compliance, valuation, or strategy and transactions, our executives are happy to assist.

In this final episode of PYA's Revenue Recharge series, we reviewed other net revenue opportunities from governmental payers. In addition, we recapped the first six episodes and provided a sample assessment tool to help identify your net revenue opportunities. The webinar took place on September 26, 2024. PYA Director of Reimbursement Services Emily Wetsel and Principal Bob Paskowski addressed the following key learning objectives: Identify net revenue opportunities from government-funded sources Recap the highlights from Episodes 1-6 Share a sample assessment tool for net revenue opportunities This webinar was Episode 7 of PYA's Revenue Recharge series. In the series, PYA shares ways health systems and physicians can identify revenue opportunities, leading to a more sustainable and visionary future and better healthcare for patients. By addressing net revenue opportunities in your operational planning, you can support your mission. Watch previous episodes of the Revenue Recharge webinar series. If you would like assistance with revenue management and strategies or any other area related to healthcare operations, strategy and transactions, or valuation, our executives would be happy to assist.

For decades, healthcare providers have been challenging regulations in court. In many cases, judges cited Chevron deference as the basis for upholding agencies' interpretations of authorizing statutes. In summer 2024, however, the Supreme Court in Loper Bright Enterprises overruled Chevron, ruling that courts–not agencies–are responsible for interpreting ambiguous statutory provisions. During this webinar, PYA's Martie Ross and Kathy Reep: Gave a straightforward explanation of Chevron deference and the practical impact of the Loper Bright Enterprises decision Addressed the immediate and longer-term impacts—both good and bad—of the Supreme Court's decision on healthcare providers Discussed lessons learned from earlier lawsuits challenging healthcare regulations and what they expect to see from providers looking to protect their interests through the rulemaking process and subsequent litigation. The webinar took place on September 25, 2024. This webinar is part of PYA's twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. If you would like assistance with reimbursement, regulatory impacts, or any matter involving compliance, valuation, or strategy and transactions, our executives would be happy to assist.

On August 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the 2025 Medicare Hospital Inpatient Prospective Payment System (IPPS) final rule. PYA's Martie Ross, Kathy Reep, and Carine Leslie hosted a discussion of the final rule's key provisions: Rate increases and wage index changes Mandatory Transforming Episode Accountability Model (TEAM)   New quality measure reporting requirements Updates to the Promoting Interoperability program Payments for establishing and maintaining access to essential medicines Resources for treating patients with inadequate housing Overview of the inpatient psychiatric facility (IPF), inpatient rehab facility (IRF), and skilled nursing facility (SNF) prospective payment systems for FY 2025 The webinar was presented on September 4, 2024. This webinar was part of PYA's twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. If you would like assistance with preparing for TEAM or with reimbursement, regulatory impacts, or any matter involving compliance, valuation, or strategy and transactions, our executives would be happy to assist.

In 2024, PYA has sought to understand the toughest, timeliest, and trickiest topics in fair market value (FMV) and physician compensation in our Timely, Tough, or Tricky (TTT) webinar series. We started with a survey of more than 100 physician compensation experts and other healthcare professionals and have continued to collect questions during the 2024 TTT season with the goal of tackling those questions each month. In the spirit of the Olympics, PYA Principals Lyle Oelrich and Angie Caldwell addressed your timeliest, toughest, or trickiest issues during the webinar, "Going for Gold in Physician Compensation Planning," on August 27, 2024. Webinar attendees gained knowledge through these discussion topics: What lessons can be learned from recent governmental complaints involving physician compensation to help with your planning efforts? What are some tips and best practices to remember when planning and designing physician compensation?

Many providers have significantly improved their revenue by participating in value-based contracts. Most providers, however, remain reluctant to enter into such arrangements because they do not believe they are prepared to manage downside risk. Presented on August 22, 2024. During this webinar, we examined many aspects of value-based care and how it impacts your revenue. PYA Principals Jane Jerzak and Martie Ross addressed the following key learning objectives: Explain the mechanics of various value-based payment models Discuss the status of the transition from fee-for-service to value-based payments Make the case for providers to move forward with a value-based contracting strategy Discuss critical first steps in pursuing such a strategy