The proposed rule is designed to reduce red tape associated with enrollment in Medicaid and related programs. In a move that some might surmise as
New guidance follows a report to CMS by the OIG on Medicare Advantage Organization’s inpatient clinical criteria in denying claims. EDITOR’S NOTE: This story is
Understanding Medicaid’s Money Follows the Person (MFP) demonstration. This past week, the Centers for Medicare & Medicaid Services (CMS) announced that it would be expanding
Complaints are abundant from beneficiaries. Last week saw the release of another audit of a Medicare Advantage (MA) plan from the U.S. Department of Health
Aside from fraud and abuse associated with telehealth, the future of this technology is astonishingly bright and innovative. Responding to COVID-19, the Department of Health
Covid, OPPS and medical necessity certificates are reported here. There is good news on the COVID-19 public health emergency (PHE) front. We now know the
How many times have we panelists talked about COVID and COVID exceptions to the regulatory rules? How many times have we warned providers that the
Portions of the “Inflation Reduction Act” benefit Medicare recipients and those insured through the Affordable Care Act Marketplace. The impacts include the following: Enhanced federal
Appeal rights appear much narrower than many expected. Earlier this year, a federal appeals court issued an opinion on Barrows v. Becerra, a long-running class
Industry concentration in the Medicare Advantage industry. Why should the United States have a single Medicare system when it can have almost a thousand? In
The regulation, 42 C.F.R. § 422.101, contains requirements for benefits in a Medicare Advantage plan. Over the last few years, we have had several segments
The proposed rule includes expansions to the Physician Payment Schedule as well as a focus on access to high-quality care. The Calendar Year 2023 Physician
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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