Federal officials said the health system received overpayments of at least $2.4 million from 2014 through 2016. The University of Wisconsin Hospitals and Clinics Authority
If there is a pattern of inappropriate denials, report it to your CMS regional office Are all of you refreshing your browser every 15 minutes
Many hospitals have found that putting SIBRs into place is incredibly challenging. The Case Management Society of America’s (CMSA’s) 28th Annual Conference and Expo recently
Better ED quality measures, and, ultimately, greater patient satisfaction are among benefits cited. The placement of registered nurse (RN) case managers in the emergency department,
Those in post-acute care should frequently check for any new reports on this subject. The Centers for Medicare & Medicaid Services (CMS) sponsored an FAQ
Legislation establishes the 2018 therapy cap level of $2,010 as a threshold level. The therapy caps have been eliminated! It has been a long and
The PIM is a woefully inadequate guide for audits leveraging extrapolation. EDITOR’S NOTE: This is the fourth in a series of reports on alleged bias
In the Medicare world, 24 hours often does not equal one day. The headline seems to ask a simple question, but in the Medicare compliance
Providers urged to review potentially eligible claims and consider participation in the expanded SCF process. The Office of Medicare Hearings and Appeals (OMHA) publicly implemented
The whistleblower brought this suit under the federal False Claims Act. The False Claims Act (FCA) allows a private party (known as a “relator” or
If a patient does not have liability for a particular expense, the insurer is similarly absolved of responsibility. The June 14 issue of RACmonitor focused
Observation is a service, not a status. As we have all seen in recent events on television, choice of words matters. That’s particularly true 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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