Catalog
This course was recorded live at our 2026 Annual Conference.
Pricing: Diplomate Members $ 31.00 - Professional Members $ 37.00 - Non-Members $ 44.00
Upon completion of this activity, members of the interprofessional team should be able to:
Recognize when a plan's decision during a hospital stay counts as an appealable coverage decision. One example is changing a patient from inpatient to observation.
Explain who must get a denial notice: the patient and the provider. Also know that if the plan doesn't send the notice on time, that failure can be appealed.
Apply the new rule that a plan can't reverse an approved inpatient admission later. The only exceptions are an obvious error or fraud.
Tell the difference between a claim payment dispute the patient can't appeal and a coverage decision the patient can.
Build a hospital workflow that uses the new 2026 prior authorization deadlines to catch plan denials and appeal them quickly.
Faculty includes:
Hemant Gupta MD, MSc, CHCQM – Healthcare Advisor
Faculty Disclosure
Members of the Education Committee, Planners, and Faculty have no relevant financial relationships with ineligible companies to disclose.
This activity is valid from October 5, 2026 through October 4, 2028.
Original release date: September 24, 2026.
Pricing:
Diplomate Members $31.00
Professional Members $37.00
Non-Members $44.00
About this item
This course was recorded live at our 2026 Annual Conference.
Pricing: Diplomate Members $ 31.00 - Professional Members $ 37.00 - Non-Members $ 44.00
Upon completion of this activity, members of the interprofessional team should be able to:
- Recognize when a plan's decision during a hospital stay counts as an appealable coverage decision. One example is changing a patient from inpatient to observation.
- Explain who must get a denial notice: the patient and the provider. Also know that if the plan doesn't send the notice on time, that failure can be appealed.
- Apply the new rule that a plan can't reverse an approved inpatient admission later. The only exceptions are an obvious error or fraud.
- Tell the difference between a claim payment dispute the patient can't appeal and a coverage decision the patient can.
- Build a hospital workflow that uses the new 2026 prior authorization deadlines to catch plan denials and appeal them quickly.
Hemant Gupta MD, MSc, CHCQM – Healthcare Advisor
Faculty Disclosure
Members of the Education Committee, Planners, and Faculty have no relevant financial relationships with ineligible companies to disclose.
This activity is valid from October 5, 2026 through October 4, 2028.
Original release date: September 24, 2026.
Pricing:
Diplomate Members $31.00
Professional Members $37.00
Non-Members $44.00
Course/Activity Information
ACCREDITATION & CREDIT
In support of improving patient care, the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 
This activity was planned by and for the healthcare team, and learners will receive 1 Interprofessional Continuing Education (IPCE) credit for learning and change.
Physicians
ABQAURP designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nurses
This activity is designated for 1 nursing contact hour.
Osteopathic Physicians
This program is approved for Category 2 credit by the American Osteopathic Association.
Physician Associates
ABQAURP has been authorized by the American Academy of Physician Associates (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1 AAPA Category 1 CME credit. Approval is valid until September 10, 2028. PAs should only claim credit commensurate with the extent of their participation.
Social Workers
As a Jointly Accredited Organization, ABQAURP is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. Regulatory boards are the final authority on courses accepted for continuing education credit. Social workers completing this course receive 1 general continuing education credit.
This course is intended for Physicians, Nurses, and Other Health Care Professionals with appropriate CME / CE credit offered for each profession.
All participants must achieve a final assessment score of at least seventy percent (70%) for recertification and continuing education credits. You have 60 days to complete the course after ordering.
This activity is valid from October 5, 2026 through October 4, 2028. Original Release Date: September 24, 2026.
About the Author:
Hemant Gupta MD, MSc, CHCQM
Dr. Hemant Gupta is a physician executive, board-certified internist, and healthcare strategist with extensive experience in medical management, UM physician advisory services, and clinical informatics. He's held national and health system leadership roles, including National Chief Medical Officer for Network for UM Strategy and Innovation at UnitedHealthcare, senior CMI roles at major health systems, including Ascension, and physician advisory leadership roles with Sound Advisory. He's also an active hospitalist, a healthcare advisor, an entrepreneur focused on improving care delivery and reducing administrative friction and advancing technology and AI in healthcare.