Vulnerable seniors, especially those with underlying health conditions, have been of particular concern to those working to stem the coronavirus pandemic.
Federal authorities have rolled out guidance for entities that serve senior populations, which are of particular concern to the nationwide corps of healthcare professionals seeking to curb the ongoing COVID-19 pandemic.
The Centers for Medicare & Medicaid Services (CMS) issued guidance Tuesday to all Programs of All-Inclusive Care for the Elderly (PACE) organizations, which work with the federal Medicare and Medicaid programs to help people meet their healthcare needs in the community instead of going to a nursing home or other type of facility.
PACE is the latest area of focus because, as CMS noted in a press release, “these organizations serve older adults who often have serious chronic medical conditions, and therefore are at higher risk of serious illness from the virus.” The guidance, part of the White House Coronavirus Task Force efforts, offers what authorities described as “clear, actionable information” on accepted policies and standard procedures with respect to infection control. CMS also said it would “use discretion … if PACE centers need to implement strategies to mitigate the spread of the virus that are not in full compliance with the program’s requirements.”
There are now more than 6,500 coronavirus cases reportedly documented in the U.S., including at least one in all 50 states, with more than 200,000 cases worldwide, resulting in 115 deaths domestically and 8,200 globally.
“Today we announced guidance to PACE organizations to keep the beneficiaries who use these services healthy and safe,” CMS Administrator Seema Verma said in a statement. “It is critically important to ensure that those most at risk of serious illness from COVID-19 are protected in every care setting, including the seniors who rely on PACE centers as healthcare providers in their daily lives.”
In particular, CMS reported, the new guidance directs all PACE entities to establish, implement, and maintain a documented infection control plan and frequently monitor for potential symptoms of respiratory infection. Such entities experiencing an increased number of respiratory illnesses among participants, caregivers, and/or healthcare and PACE personnel should immediately contact their state and local health officials for further guidance. The guidance also states that PACE personnel should be given and trained on the use of recommended personal protective equipment (PPE).
“CMS recognizes that there may be circumstances where a (PACE provider) needs to implement strategies that do not fully comply with programmatic requirements in order to protect beneficiaries from the spread of the virus. The agency will take those situations into consideration when conducting monitoring or oversight activities,” CMS’s press release read. “This will allow (providers) to use strategies including, for example, using telehealth, to provide patient assessments that would normally be conducted on an in-person basis, or limiting PACE center attendance in order to minimize the potential for exposure.”
The guidance also outlined that PACE providers can ensure access to Part D drugs by relaxing “refill-too-soon” edits and providing maximum extended-day supplies, providing home or mail delivery of Part D drugs, and waiving prior authorization requirements at any time that they otherwise would apply to Part D drugs used to treat or prevent COVID-19, if or when such drugs are identified.
Let’s start with what seems to be a never-ending topic of conversation: the new policies by Medicare Advantage (MA) plans to deny or reduce payments
As of Jan. 1, the Centers for Medicare & Medicaid Services (CMS) initiated a three-year phase-out of the Inpatient-Only (IPO) List, which fundamentally reshapes how
Please log in to your account to comment on this article.
Expert presenters Kathy Pride, RHIT, CPC, CCS-P, CPMA, and Brandi Russell, RHIA, CCS, COC, CPMA, break down complex fracture care coding rules, walk through correct modifier application (-25, -57, 54, 55), and clarify sequencing for initial and subsequent encounters. Attendees will gain the practical knowledge needed to submit clean claims, ensure compliance, and stay one step ahead of payer audits in 2026.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
