Tom Loeblein

Self-funded health plan employers: The Consolidated Appropriations Act of 2026 and the Department of Labor’s proposed fee‑disclosure regulations would significantly expand federal oversight of Pharmacy Benefit Managers (PBMs), though with different scopes and implementation timelines. This document highlights key requirements plan sponsors need to understand as they prepare for these new federal regulatory developments. Let me know how I can help guide you through these disruptive times, I am here to help!

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Entrepreneurship is not for the faint of heart — and I’m incredibly proud of my mother-in-law for stepping out and launching Precision Medical Pay of North Carolina. She helps hospitals and physician practices navigate the complex world of insurance billing and revenue cycle management — strengthening processes and improving financial performance along the way. If you’re connected to healthcare leaders, practice managers, or hospital teams, I’d love for you to follow her page and help spread the word.

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RCM: The Test Shows Up in the Details The test is not a concept; it is a moment. It’s when a claim hits the system and no one’s sure who owns it. It’s when a denial lands and the audit trail is missing. It’s when a provider asks why something wasn’t paid and the answer isn’t clear. It’s when AR flags a pattern and the root cause is buried under assumptions. That’s the test. It doesn’t care how well the process worked last month. It shows up in real time, with real consequences. This is how we handle that .... • We trace the claim from start to finish no shortcuts. • We check documentation, coding, and system logic not just the last touchpoint. • We name the gap, assign the fix, and make sure it holds. • We don’t wait for escalation to validate the issue. We own it early. Because in RCM, the test is not about blame. It’s about whether the process holds under pressure and whether the team does too.

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Shannon Sumner, CPA, CHC, managing principal of PYA’s Nashville office and chief compliance officer, warns that physicians and practice leaders face sharper scrutiny in 2026 as enforcement becomes more data-driven. She points to Centers for Medicare & Medicaid Services (CMS), the U.S. Department of Justice (DOH), and the HHS Office of Inspector General (OIG) as intensifying focus on billing, coding, documentation integrity, telehealth, Medicare Advantage risk adjustment, value-based care, privacy, and cybersecurity. Sumner explains that physician practices can now be flagged through analytics when their patterns differ from peers, leaving little room for error. She also emphasizes stronger internal monitoring, targeted audits, role-specific training, written policies, and corrective action planning. PYA’s perspective reinforces that proactive compliance, legal review, and AI governance are essential to reducing fraud, abuse, and operational risk. Our RCM team strengthens revenue cycle and implementation processes by helping health entities improve compliance readiness, documentation integrity, denial prevention, workflow accountability, and payer performance. Through practical process support and sustainable strategies, we help clients and communities reduce risk, protect reimbursement, and build stronger programs that endure and grow responsibly. Let’s CoSource! By strategically CoSourcing parts of your processes, your practice or facility can prevent revenue leakage and strengthen financial performance. Connect with us today at 855-676-8326 to explore how much you could save! #RevenueCycleManagement #HealthcareCompliance #ShannonSumner #PYA #CMS #DOJ #OIG #MedicareAdvantage #TelehealthCompliance #LetsCoSource Medical Economics https://lnkd.in/ermHMMSz

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Cost Segregation Audit Red Flags: Avoid IRS Problems! Thinking about a cost segregation study for your dental building—but worried about an IRS audit? In this video, we break down the biggest cost segregation audit red flags, why audits happen, and what the IRS looks for when reviewing depreciation studies. 🔗 Watch the full episode here: https://lnkd.in/gc_tWxts 👉 Subscribe for more tax, real estate, and lifestyle freedom strategies for dentists: ✅ https://lnkd.in/g772nM5T #CostSegregation #CostSegregationAudit #DentalRealEstate #DentalBuilding #IRSRedFlags #RealEstateTaxStrategy #Depreciation #DentistInvesting #TaxPlanning #LifestyleDentist

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Implementing Proactive Revenue Cycle Policies and Procedures: Stop Chasing Money. https://buff.ly/HMPpByM https://zetter.com #practicemanagement #medicalbilling #credentialing #zetterhealthcare #consulting #healthcare #physicians #compliance #business #healthcareconsulting #CHBC #practicestartups #revenuecyclemanagement #RCMA #PracticeCashFlow #PracticeRevenue #PracticeManagement #PracticeManagementConsulting @Health Care Compliance Association (HCCA) @American Alliance of Orthopedic Executives (AAOE) @National Organization of Rheumatology Management-NORM @Healthcare Business Management Association (HBMA) @Healthcare Industry Professionals Group @Society of Physician Entrepreneurs (SoPE) @Healthcare Executives @Healthcare Executives Network (HExN) @Healthcare Executive US Networking Group @Health & Wellness PRACTITIONERS Networking Group @Managed Care Contracting Group @Healthcare & Medical Practice Professionals @Medical Billing & Coding Forum @Healthcare Revenue Cycle Sales Professionals @Managed Care Provider Contracting @American Health Law Association (AHLA) @Association for Healthcare Administration Professionals @Modern Healthcare @Physicians Practice America’s Leading Practice Management Resource @Health and Hospital Lawyer Network @Urgent Care Development & Management @Healthcare Physician Practice Management @Healthcare Law & Compliance Institute @Managed Care Connections @Administrator Support Community for ENT @American College of Rheumatology @American College of Cardiology @American Health Law Association @National Society of Certified Healthcare Business Consultants (NSCHBC) @NAMAS National Alliance of Medical Auditing Specialist @American Medical Billing Association (AMBA) @American Medical Association @AAPC @Medical Group Management Association (MGMA) @Healthcare Financial Management Association (HFMA)

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