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

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.

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.

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.

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.

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.