The Centers for Medicare & Medicaid Services (CMS) proposed a rule intended to reduce what it describes as excessive state payment practices, and to redirect
The Centers for Medicare & Medicaid Services (CMS) has finally released its long-awaited No Surprises Act (NSA) Independent Dispute Resolution (IDR) Final Rule, introducing a
If you follow False Claims Act (FCA) enforcement, you’ve probably noticed a shift over the last few years. The classic whistleblower – the insider, the
Workplace stress has become one of those topics that organizations can no longer afford to treat as an individual issue. While stress has always existed
Healthcare compliance has entered the machine-learning era, and most organizations have not yet noticed. Providers are using artificial intelligence (AI) to generate documentation, surface reimbursable
Let’s admit it: the International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM) official conventions, guidelines, and advice involving sepsis and its consequences have been
The Centers for Medicare & Medicaid Services (CMS) is continuing its multi-year push toward payment accuracy, documentation integrity, and value-based care. While the most visible
When you hear about pixels, you might think of computer screens – the smaller the pixels, the better the image. Or you might think of
In March, the U.S. Supreme Court issued a decision in the case of Chiles v. Salazar. The decision raises many questions and fuels speculation. But
This month, the Secretary of the U.S. Department of Health and Human Services (HHS) – Robert F. Kennedy, Jr. – testified at seven congressional committee
A few weeks ago, Dr. Ron (Ronald Hirsch, MD) wrote about a situation in which members of a utilization review (UR) staff were uncomfortable with
Last summer’s Loper Bright decision was supposed to be a watershed moment for administrative law. By overturning Chevron deference, the U.S. Supreme Court declared that
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.
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.
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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