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Description
Starting January 2026, payers will be required to adopt FHIR-based API workflows, shorter turnaround times (standard in 7 days, expedited in 72 hours), and greater transparency in prior authorization.
Learning Objectives
- Understand the core requirements of the CMS 2026 prior-authorization rule and downstream impact for providers.
- Map changes into hospital RCM workflows: intake, documentation, approval turnaround, tech stack.
- Develop an action plan (people, process, tech) to mitigate the risk of delays, denials, and revenue impact.
- Key Value Proposition: Ensures your hospital isn’t caught off-guard by the new prior authorization regime — readies your RCM workflows for an impending shift with direct revenue risk.
Areas Covered
The Wasteful & Inappropriate Service Reduction (WISeR) model is a pilot program that introduces prior authorization for certain services under traditional (Original) Medicare in six states, effective January 1, 2026. The program will run through December 31, 2031.
Why Should You Attend
The program's intent focuses on the reduction of fraud, waste & abuse in federal healthcare spending & preventing payment for services that are low-value or not medically necessary. This is a mandatory pilot program applicable to six states, including Arizona, New Jersey, Ohio, Oklahoma, Texas & Washington. This webinar will review the types of outpatient procedures & items considered at risk for overuse or fraud that will require authorization. Included will be documentation requirements and how to appeal denied claims. Ensure you and your staff understand the expectations and implementations needed to protect your revenue.
Who Should Attend
- Physicians
- Mid-level providers
- Coders
- Billers
- Revenue cycle staff
- Risk Management
- Nurses
- Denial management
- Practice managers
- Appeals staff
Speaker
Dorothy Steed CCS, CDIP, COC, CPCO, CPUM, CPUR, CPHM, CPMA, ACS-OP, CCS-P, RCC, RMC, CEMC, CPC-I, CFPC, PCS, FCS, CPAR Independent Healthcare Consultant and Educator Dorothy Steed is an Independent Healthcare Consultant and Educator in Atlanta. She was a Medicare specialist for a large hospital system and a physician audit supervisor for another hospital system, with 40 years of experience in healthcare.
Additionally, she is an instructor at a state technical college in Atlanta, provides auditing & training in both facility and physician services, and has been a speaker at several healthcare conferences. Ms. Steed has written articles for several medical publishers and served as a contributing author for medical billing and coding training material.
She writes online courses and is an AHIMA-certified ICD-10-CM/PCS trainer. Ms. Steed is credentialed in medical coding, medical billing, medical auditing, utilization management, healthcare management, healthcare compliance, clinical documentation improvement, and patient accounts. She has served as a participant in multiple audits. She holds a Bachelor's degree with a major in business and minors in both criminal justice and sociology.