Let me start with some follow-up on a topic I have written about before: the widening of the use of “against medical advice” (AMA) to
A few weeks ago, Dr. Ron (Ronald Hirsch, MD) wrote about a situation in which members of a utilization review (UR) staff were uncomfortable with
At times, it can seem as though the chips are stacked against hospitals. There are a multitude of organizations collecting hospital claim data and monetizing
While many in hospitals find understanding the new regulations on Medicare Advantage (MA) plan denials challenging, it appears that the payers are also having a
The talk of the industry continues to be Aetna’s new policy regarding payment for inpatient admissions. If you have not heard, Aetna will approve all
I am going to start 2026 by doing something I rarely do, and that is compliment an insurance company, and United Healthcare at that. As you
It is normally that time of year when many of us not only steal candy from the kids’ Halloween collections (my kids never got to
January 2024 marked a significant change for the application of the Two-Midnight Rule for Medicare Advantage (MA) plans, when the Centers for Medicare & Medicaid
In a recent article in the prestigious New England Journal of Medicine, a rheumatologist at a teaching hospital lamented about “hospital problems,” a recent phenomenon
The news cycle never seems to rest. First, a bill has been introduced in Congress to once again try to get observation days to count
Readmissions are a common topic of concern around hospitals and rightly so, but the issue is much more complex than it seems. First, of course
With little fanfare, last week the Centers for Medicare & Medicaid Services (CMS) announced another Review Choice Demonstration Project. Joining the ongoing Review Choice Demonstration
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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