Last week was a busy week for healthcare policy in Washington. About half the Democrats in the House co-sponsored and introduced a Medicare-for-all bill, bringing
It is crucial to understand the differentiation between a denial for lack of medical necessity and a denial for incorrect status. Last week marked the
The agency still recovered more than $1 billion from healthcare providers. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG)
Dear Colleague: The World Health Organization (WHO) gave us the International Classification of Diseases version 10 (ICD-10) and up next: ICD-11. Every day, between small
The U.S. Department of Health and Human Services (HHS) has a new leader – thanks to the narrowest of margins. The U.S. Senate voted 50-49
Scammers targeted a local medical board in the name of the FBI. Here’s a story you need to share with your licensed professionals. Last week
“Beware the Ides of March,” the soothsayer in Shakespeare’s “Julius Caesar” warned, foretelling the titular character’s doom. The Ides may now be behind us, but
The iconic foundation has published three Federal Policy Recommendations to Advance Health Equity. First, I’d like to follow up on last week’s article about The
Providers should be aware of these emerging strategies for defending against audits. For years, providers have been plagued with defending claims for medically necessary services
Crime doesn’t pay, but it’s costing headaches for many. The COVID-19 vaccination program has stimulated one of the largest crime waves in history – and
Proposals were made during recent Coordination and Maintenance Committee. The healthcare industry has consistently asked when ICD-10-CM codes will better address the social determinants of
Why doesn’t CMS use business intelligence to catch fraud? You can call it business intelligence. You can call it common sense. As Medicare pays fee-for-service
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.
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.
Master the FY 2027 ICD-10-CM changes, including new diagnosis codes, CC/MCC updates, and coding guideline revisions, with practical insights from nationally recognized coding and CDI experts.
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