Today is election day. I wanted to talk about the process by which laws are passed and regulations created in healthcare.
Recently, the fall of the Chevron Doctrine has added an additional layer of complexity to regulatory interpretation, raising new questions about the future of healthcare regulation in the United States.
The legislative process begins in Congress, where bills are proposed by members of the House of Representatives or the Senate. Bills can be prompted by public needs, lobbying efforts from healthcare groups, or political initiatives. For instance, major pieces of healthcare legislation, like the Patient Protection and Affordable Card Act (ACA), are proposed as bills, debated in committees, and undergo a series of amendments before being voted on. If passed by both the House and Senate, the bill goes to the President, who can sign it into law or veto it. Upon becoming law, executive agencies are responsible for interpreting and implementing the statutes, which may involve drafting regulations.
Once a healthcare law is passed, regulatory agencies, such as the U.S. Department of Health and Human Services (HHS) or the Centers for Medicare & Medicaid Services (CMS), are tasked with drafting regulations that explain how the law will be applied in practice. This process begins with a Notice of Proposed Rulemaking (NPRM), where agencies publish proposed rules in the Federal Register, inviting comments from the public, stakeholders, and industry experts. The public comment period allows input from healthcare providers, insurance companies, advocacy groups, and individuals who may be impacted by the regulation.
After reviewing comments, the agency may revise the proposed rules and issue a final rule. This rule is then published in the Code of Federal Regulations (CFR), becoming binding. These rules clarify ambiguous language in legislation, set standards for compliance, and provide specifics that laws do not include. For example, CMS regulations under the ACA outline requirements for Medicaid expansion, insurance coverage standards, and reporting obligations.
Judicial review plays a significant role in shaping healthcare regulations. Courts may review regulations to ensure they do not exceed the authority granted by Congress or conflict with constitutional principles. The Chevron Doctrine, established by the Supreme Court in *Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc.* (1984), historically guided courts in reviewing agency interpretations of statutes. Under Chevron, courts would defer to an agency’s interpretation of an ambiguous statute, provided it was reasonable and not explicitly contradicted by Congress.
In healthcare, this meant that agencies like CMS had some flexibility in interpreting statutes under their purview. This deference allowed agencies to address complex, technical aspects of healthcare that require expertise beyond the judiciary’s scope.
The loss of Chevron deference may also lead to increased litigation as stakeholders challenge agency interpretations more frequently, believing that courts will more closely review agency decisions. This could slow the regulatory process and lead to greater uncertainty in healthcare compliance, especially as courts may lack the specialized knowledge required to make informed decisions on technical healthcare issues.
This new landscape may lead to slower and more litigious regulatory processes, impacting the ability of the healthcare system to adapt swiftly to changing needs and developments. The full implications of this shift are still unfolding, but it is clear that regulatory agencies will need to adjust their approaches to policy implementation, and healthcare stakeholders may need to prepare for a more uncertain regulatory environment.
Picture this: You are driving through an area you don’t know well. It is a cold day. You stop to get gas. You fill the
Federal health officials have announced the launch of the Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) initiative. The announcement was framed as a decisive step
Please log in to your account to comment on this article.
Sepsis sequencing continues to challenge even experienced coding and CDI professionals, with evolving guidelines, documentation gaps, and payer scrutiny driving denials and data inconsistencies. In this webcast, Payal Sinha, MBA, RHIA, CCDS, CDIP, CCS, CCS-P, CCDS-O, CRC, CRCR, provides clear guideline-based strategies to accurately code sepsis, severe sepsis, and septic shock, assign POA indicators, clarify the relationship between infection and organ dysfunction, and align documentation across teams. Attendees will gain practical tools to strengthen audit defensibility, improve first-pass accuracy, support appeal success, reduce denials, and ensure accurate quality reporting, empowering organizations to achieve consistent, compliant sepsis coding outcomes.
Expert presenters Kathy Pride, RHIT, CPC, CCS-P, CPMA, and Brandi Russell, RHIA, CCS, COC, CPMA, break down complex fracture care coding rules, walk through correct modifier application (-25, -57, 54, 55), and clarify sequencing for initial and subsequent encounters. Attendees will gain the practical knowledge needed to submit clean claims, ensure compliance, and stay one step ahead of payer audits in 2026.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
