CMS telehealth findings are expected later this month, and scrutiny is increasing.

While Medicare telehealth flexibilities remain in effect through January 30, 2026, CMS is taking a closer look at how services are documented, billed, and audited, particularly for audio-only visits and rural providers.

Now is the time to review telehealth utilization, audit documentation, and understand revenue tied to temporary flexibilities.

Preparation now creates options later.

Claim denials are rising across hospitals and provider organizations, driven by expanding prior authorization requirements, stricter medical necessity standards, and evolving CMS and payer policies. As 2026 approaches, denial prevention is becoming a critical component of financial stability. Organizations that strengthen documentation, improve workflow alignment, and monitor payer behavior proactively will be better positioned to protect revenue.

CMS is expanding its audit and program integrity efforts in 2026, and hospitals should expect increased scrutiny across outpatient services, price transparency, and documentation accuracy. These audits go beyond the OPPS and ASC Final Rule and reflect CMS’s broader focus on data integrity, billing alignment, and financial stewardship. Understanding where CMS is concentrating its attention now allows organizations to reduce audit risk and protect reimbursement.

CMS is raising the bar on hospital price transparency, and the 2026 OPPS and ASC Final Rule makes it clear that compliance is no longer just about posting files. Hospitals must now deliver complete, consumer-ready pricing that patients can understand and CMS can validate. As enforcement increases, revenue integrity, billing, and compliance teams will need stronger internal alignment to avoid penalties and protect trust.

Excerpt for Blog

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