This is the first of many reports to come on the topic of SDoH. It’s just February, but a steady stream of reports and surveys
There are five critical mistakes made by providers. By now, healthcare providers that perform “device-dependent” or “device-intensive” procedures know the follow-up steps necessary in reporting
Against Medical Advice: Are A M A Scarlet Letters? A recent discussion on Twitter caught my attention. A physician posted, “Left against medical advice” is
The final rule also clarifies the definition of “reasonable and necessary.” On Jan. 14, the Centers for Medicare & Medicaid Services (CMS) published a final rule creating
The law goes into effect Jan. 1, 2022. This time of the year, we often focus on predictions. I won’t here, for two reasons. First, predicting is
Nonprofit hospitals spend an average of $67.9 billion annually on community benefits. 2021 is off and running, and healthcare organizations are positioning themselves for success;
Certify the certifiers. Have you ever been in a Medicare hearing and realized the person testifying for the auditor does not understand what they are
Failure to integrate information systems leaves New Yorkers seeking COVID-19 vaccination out of luck. EDITOR’S NOTE: This is the first in a series of articles
Estimated savings are $75 million over a decade. Federal officials recently announced a series of changes to the Medicare Advantage (MA) and Part D prescription
The data may allow you to better understand the intricacies of hospital payments. When I teach Medicare regulations to physician advisors, case managers, and utilization
CMS levies billions of dollars in overpayments a year against healthcare providers, based on the use of extrapolation audits. The use of extrapolation in Medicare
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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