Most hospital revenue cycle leaders know exactly what a transfer DRG overpayment looks like. It looks like an OIG audit. It looks like a takeback. It looks like a recoupment letter from the MAC. CMS has built decades of edits, audits, and oversight processes designed to catch hospitals that miscode a transfer as a routine discharge and collect a full MS-DRG payment they weren't entitled to. Here's what most teams don't see as clearly: the policy is asymmetric. CMS has edits t

The Two-Midnight Rule was supposed to be settled. It was finalized more than a decade ago. CMS extended it to Medicare Advantage plans starting January 1, 2024. On November 25, 2025, CMS issued further clarifying updates in the CY 2026 OPPS Final Rule. By every reasonable measure, this should be a closed chapter. It isn't. Status determination errors — the wrong choice between inpatient and observation, the downgrade after the fact, the denial that should never have been issu

What the First Public Prior Auth Denial Reports Reveal — and How to Use Them at the Negotiation Table For the first time in history, hospitals can pull up a payer's website and see — in black and white — how often that payer denies prior authorization requests, how long they take to decide, and how many of those denials get overturned on appeal. The data is public. The accountability is new. And most hospital finance teams haven't done a thing with it. Under the CMS Interoper

The One Big Beautiful Bill Act (OBBBA) isn't just another policy shift — it's a financial earthquake reshaping healthcare revenue cycles across America. With $68.5 billion in projected hospital revenue losses over 2026-2027 and an average impact of $16.1 million per facility, healthcare CFOs face their most challenging margin environment in decades. But while most organizations scramble to react, forward-thinking hospitals are discovering that physician-led revenue cycle mana

Key Takeaways: 2026 Healthcare Revenue Cycle Changes Policy & Payment Model Transformations Telehealth Flexibility Extended Through 2026 - DEA extends controlled substance prescribing flexibility for a fourth time, requiring organizations to maintain updated coding knowledge, payer-specific policies, and proper telehealth documentation standards. 340B Program Protected from $400M Loss - Federal court injunction halts rebate model pilot, providing temporary relief while unders