EDITOR’S NOTE: Lisa Banker, MD contributed to the following report. Medicare Advantage Organizations (MAOs) were warned by federal health officials last week to issue an appealable
Congress appears to be closer on a COVID-19 relief package. U.S. Supreme Court Associate Justice Ruth Bader Ginsburg passed away on Friday. Ginsburg was the
Food insecurity is on the rise. Amid the perils of the continuing COVID-19 pandemic are now growing concerns about food shortages around the country. Since
Medicare audits expected soon.Federal healthcare audits have resumed, and they are not limited to durable medical equipment (DME) or any one specific group of providers,
Your data will determine the overall success of your denial prevention and management efforts. No matter how robust the clinical documentation integrity (CDI) program, there
Action applies to the Medicare Accelerated and Advanced Payment Loan Program. In March, the Centers for Medicare & Medicaid Services (CMS) expanded the Accelerated and
The move contrasts with shorter timelines associated with the releases of the IPPS, OPPS rules. In an apparent effort to make providers’ lives a little
Two payers allegedly inflated their bids. Earlier this month, two Independence Blue Cross (IBC) subsidiaries in Pennsylvania agreed to pay $2.25 million to resolve allegations
New study reinforces SDoH impact Focus on the social determinants of health (SDoH) continues to intensify nationwide, and that means potentially higher costs of care
Hospital medical records are under scrutiny by the Centers for Medicare & Medicaid Services. Via two unrelated changes, the Centers for Medicare & Medicaid Services
The Social Dilemma of Health (SDoH). In March 2018, the world was shocked when it became public knowledge that Cambridge Analytica, a company based in
The Centers for Medicare & Medicaid Services (CMS) recently announced updates to the 2021 Medicare Physician Fee Schedule (MPFS). Among them are unprecedented increases in
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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