Case Review Connections

Medical Director's Corner

Written by Jessica Whitley, MD, MBA

The theme of the 2026 Centers for Medicare and Medicaid (CMS) Quality Conference, “Make America Healthy Again: Innovating Together for Better Health,” signals a meaningful shift in health care and highlights new opportunities to lead, innovate, and deliver greater value.

CMS is shaping a future where prevention and overall well-being take center stage. For providers, this creates an opening to move beyond episodic care and develop more continuous, meaningful relationships with patients. Incorporating screenings for nutrition, physical activity, and behavioral health into everyday workflows allows organizations to surface risks earlier and improve outcomes, while also preparing for success in emerging value-based models.

Momentum is also building around person-centered care, particularly for older adults. The 4Ms framework, What Matters, Medication, Mentation, and Mobility, offers a practical way to strengthen care delivery. Hospitals and skilled nursing facilities (SNFs) that adopt this approach can stand out by elevating the patient’s experience and supporting smoother transitions across care settings.

At the same time, advances in technology are opening new possibilities. Artificial intelligence (AI) is becoming an increasingly valuable tool for clinicians, helping to sharpen diagnostic accuracy and flag potential risks sooner. When implemented thoughtfully, AI can enhance both safety and efficiency while supporting, not replacing, clinical judgment.

A similar focus on improvement is taking hold in areas such as diagnostic accuracy and medication safety. With increased attention from CMS, providers are refining their processes and reducing preventable errors. These efforts not only strengthen quality performance but also lead to more reliable patient outcomes.

Administrative simplification is creating additional room for progress. Efforts to streamline prior authorization and reduce low-value care are easing operational burdens and allowing clinical teams to spend more time with patients. Organizations that respond early may see meaningful gains in both efficiency and staff satisfaction.

Meanwhile, the push for interoperability and better data sharing is enabling more coordinated care. Connecting information across acute and post-acute settings gives hospitals and SNFs a clearer view of patient needs, supports population health management, and helps reduce avoidable readmissions.

There is also an opportunity to deepen patient engagement through advance care planning. Earlier and more thoughtful conversations about goals and preferences can strengthen trust and ensure that care aligns with what matters most to patients and their families.

As CMS continues to emphasize program integrity, providers have a chance to reinforce compliance efforts and make better use of analytics. Strong performance in this area not only reduces risk but also supports long-term sustainability.

Taken together, these developments point to a healthcare environment that rewards proactive, connected, and patient-centered care. For hospitals and SNFs, this is a moment to evolve, lead in quality and innovation, and create lasting impact. Those who embrace these changes will be well-positioned not just to adapt, but to thrive in the next generation of health care.

For more information, visit the CMS Quality conference website.

Appeals Update

The Office of Management and Budget (OMB) has approved updated versions of the Important Message from Medicare (IM) and the Detailed Notice of Discharge (DND). There are no changes to when or how these notices must be delivered. CMS updated them to make the language easier to understand and more consistent with other Medicare notices.

The updated forms are effective immediately and will be valid through March 31, 2029. Providers can continue using the current versions until May 15, 2026, but must switch to the new versions by that date.

You can find the new forms at www.cms.gov/bni. If you have questions, you can submit them at https://appeals.lmi.org.

Learn the Steps of Acentra Health's Appeal Process – Watch our new video to learn the steps of the process for healthcare providers.

Acentra Health Resources - Skin Cancer Awareness Month Podcast

This episode is a conversation with our guest, Dr. Angeline Brunetto, Associate Medical Director for Acentra Health. She shared information about skin cancer awareness to commemorate Skin Cancer Awareness Month, which is a May health observance.

Higher-Weighted Diagnosis-Related Group (HWDRG) Updates

Reminder: Be sure to update your contact information so the medical record request goes to the proper person. Please note that there is not a unique HWDRG contact. It is the contact for your facility.

Rural Health Updates

The CMS Rural Health Transformation (RHT) Program is a major federal initiative launched in 2025 to strengthen health care in rural communities. This document outlines the state-specific goals of the program, highlighting key spotlight initiatives and their anticipated impact.

Medicare Update

Medicare is reissuing approximately 1.3 million Medicare cards due to fraud. CMS has indicated that it is not aware of any confirmed cases of identity fraud or misuse of beneficiary information, but out of an abundance of caution, CMS is implementing proactive measures, including deactivating all fraudulently created Medicare.gov accounts and restricting the creation of new accounts from foreign IP addresses. In addition, CMS is closely monitoring claims data for any unusual or suspicious activity and is issuing replacement Medicare Beneficiary Identifiers (MBIs) where appropriate. For impacted individuals, CMS is also mailing new Medicare cards with updated MBIs to ensure continued protection.

Please inform beneficiaries that they should review their Medicare Summary Notices and Explanation of Benefits for unfamiliar charges or services and promptly report any concerns to 1-800-MEDICARE. They may also obtain free annual credit reports, and if identity theft is suspected, file reports with local law enforcement or the Federal Trade Commission.

Feedback

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