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Website title: BHM Healthcare Solutions | Utilization Management | Medical Director Services | Consulting - BHM Healthcare Solutions

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July 2026 Healthcare Awareness Observations

Use this Healthcare Awareness Observations guide for internal or external healthcare awareness campaigns.

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CMS Final Rule Reshapes Federal IDR Process Under No Surprises Act

CMS finalized significant reforms to the Federal Independent Dispute Resolution process, lowering fees, improving transparency, and introducing operational changes for payer-provider payment disputes.

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CMS WISeR Pilot Faces Congressional Challenge

Congressional lawmakers introduced resolutions seeking to overturn CMS’ WISeR AI-assisted prior authorization pilot following a GAO determination that the Medicare model should have undergone congressional review prior to implementation.

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Major Payers, Health Systems, and EHR Vendors Align with CMS Electronic Prior Authorization Initiative Ahead of 2027...

CMS announced a growing group of payers, health systems, EHR vendors, and interoperability organizations participating in its Electronic Prior Authorization Acceleration initiative ahead of 2027 interoperability and electronic prior authorization requirements.

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CMS Expands Fraud Prevention Oversight in Hospice and Home Health Sectors

CMS announced a nationwide six-month enrollment moratorium for hospice and home health agencies, signaling expanded utilization oversight, fraud prevention efforts, and increased scrutiny of prior authorization, claims review, and post-acute care management practices across the payer industry.

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