As we conclude National Case Management Week 2025 with the theme of “Guiding Journeys,” we are making a point of celebrating case management professionals who lead with heart, expertise, and purpose!
During this week’s festivities, Mary Beth Pace will share how the work of the professional case manager is getting harder, as the patients and families we journey beside are dealing with an ever-more costly, complex, and fragmented healthcare system.
Patients as consumers are struggling to juggle household discretionary spending. The latest data we have is from August, due to the federal government shutdown. It shows that healthcare expenditures account nationally for 8.3 percent of the monthly consumer price index, or CPI.
In the last 12 months, the overall CPI increased 2.9 percent. However, the healthcare services portion increased 4.2 percent, the largest percentage increase relative to housing, food, and energy costs. Individuals are truly feeling this, as average wage growth is only between 1 and 1.2) percent. This is critical information to digest as we prepare for the potential loss of marketplace subsidies and escalating insurance premiums that can only mean households will be spending more for healthcare.
As you may be aware, on July 4, the President signed into law a budget reconciliation bill, the One Big Beautiful Bill Act (OBBBA). The bill included significant policy changes to Medicaid and the Health Insurance Marketplaces. The Congressional Budget Office (CBO) score indicated that the OBBBA will lead to nearly $1 trillion in Medicaid cuts, and could result in roughly 12 million people losing Medicaid and health insurance coverage. The CBO also stated that changes to state-directed payments (SDPs) and providers’ taxes is expected to save the government $340 billion, leading to drastic payment cuts to hospitals. According to one analyst, employer health plan enrollment could rise by 3.2 million if Congress lets federal subsidies for individual coverage expire. In addition, unless extended, the Patient Protection and Affordable Care Act (PPACA) subsidies expiration will cause, on average, a 114-percent increase in premiums for 2026.
Multiple projections have the number of uninsured people nationwide rising to 28 million, a 21-percent increase.
This bill, absent any updates on expiring programs, including Disproportionate Share Hospital (DSH) cuts, telehealth and Hospital at Home will significantly impact hospitals and physicians in Medicaid expansion and non-expansion states.
We are already seeing substantial impact with the shutdown, as Congress and the President struggle to find a compromise that extends federal program legislation. In the meantime, states will soon be dipping into contingency funds to keep basic programs like Women, Infants, and Children (WIC) flowing to those who depend on them. As for telehealth and Hospital at Home, popular programs included in the current continuing resolution, we are in a holding pattern, with the Medicare Administrative Contractors (MACs) directed on Oct. 1 to place a 10-day hold on telehealth payments to avoid reprocessing, in case Congress restores the pre-pandemic flexibilities that expired Sept. 30.
Add on to this the deep cuts to research funding, and directional changes at the U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS), healthcare systems are making daily decisions about funding existing programs and future growth strategies. All of this creates uncertainty for providers, employers, and individual consumers. It is in this current climate that case management teams, who are already dealing with increasingly difficult families and decreasing local resources, will see exponentially more challenges in developing safe and effective discharge plans.
The federal government may have shut down, but there has been no pause for the 340B drug pricing program. The more than 1,600 safety-net hospitals
As Washington political gridlock keeps the nation in yet another federal shutdown, hospitals across Florida are bracing for ripple effects that could strain budgets and
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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.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
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