A union coalition for Kaiser Permanente healthcare workers reached a tentative labor deal with the hospital system on Friday that included across-the-board wage increases after 75,000 members took part in a three-day strike. Under the deal, new minimum wages will reach $25 per hour in California for union-represented employees over three years, and $23 per hour in other states where the company operates.
In somewhat related news, California investigated and found widespread issues with the delivery of mental health services, and a Kaiser Permanente subsidiary will now pay $200 million and overhaul access to care, as well as its oversight of medical groups.
Kaiser Foundation Health Plan had more than 9 million enrollees across dozens of California counties at the end of 2022. California law mandates that enrollees be offered mental health appointments within 10 business days of requests, and follow-up appointments within 10 days of those first appointments.
However, investigators reported that last year, only 44 percent of non-urgent follow-up appointments with Kaiser mental health providers were completed within the 10-day window. In 2022, non-urgent, follow-up individual appointments for behavioral health therapy were completed within an average of 18.1 business days after the prior appointment.
The Anti-Kickback Statute (AKS) makes it a crime to knowingly and willfully exchange (or offer to exchange) a gift or anything of value with the intent to gain something from the exchange. The U.S. Department of Health and Human Services (HHS) published an advisory opinion that said paying physician employees bonuses based on profits from certain procedures does not breach federal law. It is a new carve-out, created by HHS.
Whenever HHS carves out an exception to the AKS or the Stark law, I always wonder how many people were prosecuted in the past for the exact new exception. Another example is gift cards as rewards for consumers receiving substance abuse treatment; the practice has always been illegal.
However, a few years ago, HHS published an opinion that it would not prosecute behavioral health providers for doing exactly that. A caveat: don’t just present gift cards for showing up to treatment. Rewards based on clean urine drug results are fine, but only based on attendance. I thoroughly enjoyed showing Recovery Audit Contractor (RAC) auditors HHS’s advisory opinion on allowing gift cards.
The Centers for Medicare & Medicaid Services (CMS) has announced two new RAC targets. In August, CMS announced that RAC audits will review hip orthoses within the Reasonable Useful Lifetime: Excessive Units Automated. Last week, CMS announced that the RACs will investigate Hospice Care- Extended Length of Stay: Medical Necessity and Documentation Requirements.
Picture this: You are driving through an area you don’t know well. It is a cold day. You stop to get gas. You fill the
Federal health officials have announced the launch of the Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) initiative. The announcement was framed as a decisive step
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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.
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.
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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.
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.
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