PYA Webinar Recast

Hosted by PYA, P.C.

Business Management

Website RSS feed

Episodes

100

Latest episode

May 2026

Language

EN-US

About the show

Recasts of PYA's Healthcare webinars.

Listen to episodes

60 recent

May 8, 2026Episode 11358 min

Spring into 2027: CMS Proposed Rules and Payment Policy Updates for Providers

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.

April 30, 2026Episode 1121 hr 5 min

CMS Enforcement to Provider Risk: The Downstream Impact of RADV Audits

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.

April 1, 2026Episode 11149 min

Preparing for OBBBA Impacts: Medicare DSH and 340B Updates

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.

March 20, 2026Episode 11038 min

TEAM Ready: Turning Claims Data into Financial Performance

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.

March 3, 2026Episode 10954 min

Top 10 Healthcare Compliance Risk Areas Managers Need to Know

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.

February 12, 2026Episode 10858 min

How to Mitigate Risk While Auditing for Revenue Integrity: Sample Design, Interpreting Results, & Navigating Compliance Next Steps

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

February 12, 2026Episode 10759 min

Happy New Year: New Proposed Rules, New Payment Models, New Guidance

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.

February 11, 2026Episode 41 hr 23 min

Let's Get Rural: Key Policy, Payment, & Program Changes Shaping Rural Care in 2026

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.

December 15, 2025Episode 1061 hr 0 min

2026 MPFS Final Rule Part 2: Telehealth, Global Payments, and Skin Substitutes

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

December 12, 2025Episode 10559 min

2026 MPFS Final Rule Part 1: Payment, MIPS, and New Models Explained

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)