Last summer’s Loper Bright decision was supposed to be a watershed moment for administrative law. By overturning Chevron deference, the U.S. Supreme Court declared that
Combat is often described as hours of boredom intermixed with moments of sheer terror. I fear that that metaphor is increasingly applicable to Medicare enrollment. Few
Remember the backlog at the Administrative Law Judge (ALJ) level of review? Where providers routinely waited years for hearings, while recoupments proceeded and cash flow
This article will feature one part poll, one part legal discussion. First, the poll: do you have the sense that administrative law judge (ALJ) hearings
Medicare audits against healthcare providers may violate federal statutes and strip away the due-process rights guaranteed under the U.S. Constitution. How does this happen? We
The new rule also highlights how bad some auditors can be at explaining when offering a provider a rare bit of good news. Earlier this
The OIG claimed that 71 of 333 inpatient claims did not meet Medicare criteria for inpatient status. A recent report, titled “CMS Can Use OIG
A close look at three extrapolation case histories. When the COVID-19 pandemic first hit in 2020, many folks assumed that it would not be an
If overpayments are found, then the extrapolation recoupment number will go up; if underpayments are found, the extrapolation will go down. Precision matters – in
High Court ruling raises questions concerning ALJ appointments. A sneaky and under-publicized matter, which will affect every one of you reading this, slid into common
The appellate court reversed the decision of the ALJ. When you defend an overpayment finding by a Recovery Audit Contractor (RAC) or a termination of
Lack of auditor response leads to an ALJ hearing. “A stitch in time saves nine” is a pretty famous heuristic expression, but most people I
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.
Artificial intelligence is rapidly transforming healthcare revenue cycle operations, from coding and auditing to compliance and denials. Join industry leaders Pam Warren (MaineHealth) and Raemarie Jimenez (AAPC) for a live fireside chat exploring how AI is changing workflows, workforce roles, payer-provider dynamics, and compliance risk—and what organizations should be doing now to prepare.
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.
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