Federal contractors are paying particular attention to payment for COVID care. It’s time to revisit a prediction regarding COVID-related audits. Months ago, it was proposed
The defendants were charged in seven district courts spanning the country. The locations of the seven U.S. Attorney’s Offices that this week brought healthcare fraud
Incyte Corporation to pay $12.6 million. Recently, U.S. Department of Justice (DOJ) announced that the Delaware-based pharmaceutical company Incyte Corporation has agreed to pay $12.6 million to resolve allegations that
CMS has deleted official guidance on the topic but promised that new guidance is still to come. It was pure coincidence that I was going
Hospitals must keep abreast of the changes and nuances as CMS adds new procedures for prior authorizations. We are approaching the second year of the
There are glaring disparities caused by gender, race, ethnicity, and sexual orientation, as well as socioeconomic status, disability and trauma. So much routinely happens in
Brooks-LaSure will become the first Black person to lead the federal agency responsible for the administration of the Medicare and Medicaid programs. The federal agency
Many plans charge a daily copayment, starting the first day, compared to deductibles charged by traditional Medicare plans. Last fall, I reported on the rise
This is a concept introduced by CMS to address surge capacity by providing acute-care services in the home setting. Not to be confused with the
Some unlucky individuals get caught in the fraud net, not knowing the difference. All right, readers, this segment is rated “F” for fraud. It is
Providers should ask themselves five key questions to figure out how to get where they want to be. EDITOR’S NOTE: A version of this story
The proposed increase is approximately 2.8 percent. Hear ye, hear ye: there will be a Medicare reimbursement rate increase! On April 27, the Centers for
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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