Inpatient-Only List Continues to Roil Physicians

Summary highlights from the ACPA’s NPAC 2021 conference: “Advising in an Unconventional World.”

The Centers for Medicare & Medicaid Services (CMS) continues to create confusion regarding the proposal it made last year to phase out the Inpatient-Only List, only to reverse their decision months later, as noted by Dr. Ronald Hirsch at the National Physician Advisor Conference (NPAC).

This and many other topics were highlighted at the recent American College of Physician Advisors (ACPA) annual conference, titled Multifaceted: Advising in an Unconventional World. Held in a virtual format and attracting over 300 attendees, this year’s event was truly multifaceted, both in its content and the breadth of participants representing many roles and health systems.

The conference kicked off with a State of the Union address by Dr. Juliet Ugarte Hopkins, followed by the Vice President of Member Engagement, Dr. Clarissa Barnes, discussing the benefits of membership and Dr. Alvin Gore, Vice President of Operations, who reviewed the results of this year’s ACPA member survey. NPAC 2021 offered for the first time ever subspecialty tracks in professional leadership, clinical documentation integrity (CDI), revenue cycle, pediatrics, and COVID-19.

There were sessions on developing successful physician advisor programs, data presentation in healthcare, artificial intelligence, hospital metrics such as length of stay and mortality, and fighting Medicare Advantage denials. New conference highlights included networking lunchrooms organized by Medicare Administrative Contractor (MAC) region, virtual happy hours with the sessions led by expert physician advisors in the field, and APCA committee interest groups, meant to attract new members.

Each day concluded with a specialized session, including an observation panel discussion on Medicare Advantage plans, an inaugural quiz bowl testing attendee knowledge, and an Expert Physician Advisor panel. The expert panel was moderated by Dr. Hirsch and included current and past ACPA presidents answering provocative questions submitted by attendees.

Several key discussions were must-see sessions for participants. Dr. Brian Moore addressed how to use CMS regulations to force Medicare Advantage plans to provide timely authorization for post-acute care services. He shared a templated fax physician advisors can use to quickly get Medicare Advantage plans to reconsider initial denials for post-acute care, which has been used successfully, with overturn rates greater than 75 percent. These templates will be shared on the ACPA website, along with regulatory references, over the coming months. Dr. Timothy Brundage also provided an excellent update on COVID-19 documentation essentials and reminded us of the importance of accurately capturing and reporting the unique aspects of COVID-19 infection.

Dr. Edward Hu delivered an in-depth explanation of the ever-evolving sepsis criteria, while Dr. Andrew Fletcher demonstrated the value of clinical laboratory medicine in partnering with case management. Day three opened with a bang, as Dr. Mary McLaughlin Davis discussed strategies for physician advisors to further collaborate with case managers.

It goes without saying that these topics and networking moments will inspire innovations that will be brought back to organizations across the country. The ACPA is excited about the growing field the physician advisor role represents, and the excitement was palpable, even on a computer screen, during the three-day conference.

On behalf of the ACPA, we cannot wait to see you in Austin for NPAC 2022 – Exploring the Spectrum: Leadership through Collaboration & Diversification!

Facebook
Twitter
LinkedIn

Carolyn Dutton, MD, FACEP, FACP, CHCQM-PHYADV

Carolyn Dutton is triple board-certified in Emergency Medicine, Internal Medicine, and Quality Assurance and Utilization Review, with a focus in Healthcare Quality Management. Dr. Dutton is also a Certified Wound Specialist Physician. Her interests include multi-disciplinary wound care and serving as a system-level senior physician advisor. She is also a Certified Healthcare Financial Professional. Dr. Dutton is the medical director at Atrium Health University City Wound Care Center, where she also serves as the physician advisor for Utilization Management and Physician Advisor Services.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Sepsis Sequencing in Focus: From Documentation to Defensible Coding

Sepsis sequencing continues to challenge even experienced coding and CDI professionals, with evolving guidelines, documentation gaps, and payer scrutiny driving denials and data inconsistencies. In this webcast, Payal Sinha, MBA, RHIA, CCDS, CDIP, CCS, CCS-P, CCDS-O, CRC, CRCR, provides clear guideline-based strategies to accurately code sepsis, severe sepsis, and septic shock, assign POA indicators, clarify the relationship between infection and organ dysfunction, and align documentation across teams. Attendees will gain practical tools to strengthen audit defensibility, improve first-pass accuracy, support appeal success, reduce denials, and ensure accurate quality reporting, empowering organizations to achieve consistent, compliant sepsis coding outcomes.

March 26, 2026
I022426_SQUARE

Fracture Care Coding: Reduce Denials Through Accurate Coding, Sequencing, and Modifier Use

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.

February 24, 2026
Mastering Principal Diagnosis: Coding Precision, Medical Necessity, and Quality Impact

Mastering Principal Diagnosis: Coding Precision, Medical Necessity, and Quality Impact

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.

December 3, 2025

Proactive Denial Management: Data-Driven Strategies to Prevent Revenue Loss

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.

November 25, 2025

Trending News

Featured Webcasts

Mastering MDM for Accurate Professional Fee Coding

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.

March 31, 2026

The PEPPER Returns – Risk and Opportunity at Your Fingertips

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.

March 19, 2026

Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue

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.

January 29, 2026

AI in Claims Auditing: Turning Compliance Risks into Defensible Systems

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.

January 13, 2026

Trending News

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