April 2026: Regulatory Notice - The R.I.S.E Series
Part 1 of 4 of The R.I.S.E Series for Behavioral Health Facility Owners
April 2026: Regulatory Notice - The R.I.S.E Series
Part 1 of 4 of The R.I.S.E Series for Behavioral Health Facility Owners
PROTECT YOUR REVENUE
If it feels like scrutiny has escalated overnight — it has.
More denials. More record requests. More prepayment reviews slowing down reimbursement and putting pressure on your cash flow.
This isn’t random.
Payors are under regulatory pressure like never before. In California, DMHC penalized Anthem with a $15 million fine, and DHCS issued monetary sanctions. CMS restructured the distinct IOP benefit nationally in 2024. Every payor in every state is recalibrating — and the scrutiny is rolling downhill fast.
Your TIN. Your NPI. Your revenue. Your risk.
Overview of The R.I.S.E. Series
A 4-Part Series for Behavioral Health Facility Owners | April–July 2026
R — Regulatory Notice I APRIL
Your payors are on notice. Audits are accelerating. California is where the hammer is falling first — but this is national.
I — Impact & Exposure I MAY
Your financial and legal exposure is real. Full recoupment, interest, penalties, network exclusion, and potential fraud referrals. Six to seven figures.
S — Standards in Coding I JUNE
If your codes aren’t compliant, you’re the one holding the bag — not your billing company. Their name isn’t on the claim. Yours is.
E — Enforcement & Rights I JULY
The only defense is knowing your regulatory rights — how to challenge denials, demand transparency, and hold your billing partner accountable.
EPISODE 1 — APRIL 2026
R — Regulatory Notice
What’s happening out there — and why it should concern every facility owner, in every state.
Thank you to everyone who joined us this month as Erin Burke, CEO & Founder of Hansei Solutions, sat down with Jenna Joneikis, CCS, CRCR, CSPR — Hansei’s Senior Revenue Integrity Analyst and AHIMA-certified coder — for an unfiltered look at what’s happening in behavioral health billing right now.
Jenna is the analyst who identified the HCPCS coding gaps currently putting California facilities at risk of full recoupment. In this session, she walked through what she found, why it matters, and what the patterns tell us about where enforcement is headed next.
Jenna Joneikis
Senior Revenue Integrity Analyst
Hansei Solutions
Erin Burke
CEO & Founder
Hansei Solutions
WHAT WE COVERED
The regulatory landscape is shifting fast
What’s driving the surge in audits, denials, and medical record requests — and why behavioral health is seeing more aggressive scrutiny than other specialties.
Prepayment reviews are rising — and impacting cash flow
This isn’t just about post-payment audits anymore. Payors are increasingly reviewing claims before they pay them, delaying reimbursement and creating immediate financial pressure for facilities.
California is the flashpoint — but not for long
The enforcement patterns emerging in California are a leading indicator. Other states are close behind, and similar audit activity is expected nationwide.
The coding and documentation gaps putting facilities at risk
Jenna highlighted specific patterns in the data — including insufficient detail on claims and documentation — that are triggering audits and exposing facilities to recoupment.
The operational burden of audits is growing
From record requests to payer communication, audits are becoming more frequent, more complex, and more resource-intensive — and most teams are not staffed to handle the volume.
How to evaluate if your RCM partner is protecting you — or exposing you
If your billing isn’t defensible, your facility is the one at risk. Your name — not your vendor’s — is on the claim.
KEY TAKEAWAYS
This isn’t just “more audits.” It’s:
Prepayment reviews delaying cash flow
Increased scrutiny on documentation and coding
Larger, longer, more complex audit cycles
Financial exposure tied directly to your NPI
The question isn’t if you’ll be reviewed — it’s whether you’re prepared when it happens.
Accurate, detailed documentation is no longer optional — it’s your first line of defense
Waiting for an audit is already too late — proactive compliance is critical
Understanding payer and auditor expectations can directly impact outcomes
Facilities must be equipped — both in expertise and manpower — to manage audit volume effectively
WHAT’S NEXT IN THE SERIES
I — Impact & Exposure | MAY
Your financial and legal exposure is real.
Full recoupment. Interest. Penalties. Network exclusion. Potential fraud referral.
Six to seven figures.
We’ll break down exactly what’s at stake — and how to quantify your risk.
Join us for Part 2:
Add to calendar below.