Part 2: How You Can Lose Without Knowing It
Frank Cohen, MPA
June 15, 2026
In Part One of this series, I described how healthcare compliance has become a chess match between AI on the provider side and AI on
In Part One of this series, I described how healthcare compliance has become a chess match between AI on the provider side and AI on
The federal Targeted Probe and Educate program, commonly known as TPE, is not new. But as Medicare medical review activity continues to focus on accuracy,
The regulatory landscape surrounding telehealth has undergone numerous changes over the past several years. Temporary flexibilities granted during the federal Public Health Emergency (PHE) created
What is the significance of the addition of the phrase ‘when performed’ in the revised descriptors for CPT® codes 93571 and 93572?
What is the correct billing structure for ventilation management services described by CPT® codes 94002 and 94003?
How should iliac artery atherectomy be coded when performed with angioplasty and/or stenting during the same procedure?
What are common clinical conditions that can lead to a Type 2 myocardial infarction (MI)?
When can both flow cytometry and immunohistochemistry (IHC) be reported together with modifier 59 or XU?
Behavioral health is one of the fastest-growing areas of healthcare today, yet many organizations are struggling to keep pace with the operational, coding, documentation, and
One oft-overlooked fact of life about being a lawyer is the constant need to research. I think that the desire to learn is often the
Last week I had an interesting conversation with a case management director about everyone’s favorite topic: the Medicare Advantage (MA) plans. Like all businesses, her
Policies have the potential to be quite a double-edged sword. Generally speaking, managers love policies, and I think there are several reasons for this. Perhaps the
CMS CRUSH (Comprehensive Regulations to Uncover Suspicious Healthcare) signals a new era of data-driven program integrity oversight that extends far beyond coding and CDI. As federal scrutiny of claims, documentation, billing practices, provider enrollment, and payment accuracy intensifies, healthcare organizations must be prepared to identify and address vulnerabilities before they result in audits, denials, repayments, or enforcement actions. Join us for this timely webcast to learn what CMS CRUSH could mean for your organization and discover practical strategies to strengthen documentation, claims integrity, compliance readiness, and reimbursement defensibility.
Medicare regulations are complex and even seasoned professionals struggle to apply them consistently. Due to overwhelming demand, Dr. Hirsch returns for Part 2 of Ask Dr. Hirsch: Clarifying Medicare’s Most Misunderstood Rules to answer even more of Medicare’s most misunderstood questions, covering inpatient status, observation, SNF access, Medicare Advantage denials, and more. Join Dr. Hirsch as he provides clear, referenced answers to real-world questions submitted by your peers, helping you navigate Medicare compliance with confidence and clarity.
Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
Artificial intelligence is rapidly transforming healthcare revenue cycle operations, from coding and auditing to compliance and denials. Join industry leaders Pam Warren (MaineHealth) and Raemarie Jimenez (AAPC) for a live fireside chat exploring how AI is changing workflows, workforce roles, payer-provider dynamics, and compliance risk—and what organizations should be doing now to prepare.
Prepare for FY 2027 IPPS changes with a comprehensive 3-part masterclass covering ICD-10-CM/PCS updates, MS-DRG shifts, NTAPs, compliance risks, and reimbursement strategies.
Stay ahead of FY 2027 reimbursement changes with expert analysis of MS-DRG shifts, NTAP updates, Medicare Code Edits, and emerging technologies impacting inpatient payment accuracy.
Stay ahead of FY 2027 ICD-10-PCS changes with expert analysis of new procedure codes, revised guidelines, and high-impact updates affecting reimbursement, compliance, and inpatient coding accuracy.
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