The Centers for Medicare & Medicaid Services are levying civil monetary fines for non-compliant hospitals. The feds are going after hospitals they believe are not
Five years ago, the Centers for Medicare & Medicaid Services (CMS) first compiled a list of services that the newly implemented recovery audit contractor (RAC)
Double-dipping has been seen among some Managed Care Organizations. How many readers have undergone more than one audit? What about more than one audit for
New changes impact the ADR limits for RACs. The Centers for Medicare & Medicaid Services (CMS) has modified the additional documentation request (“ADR”) limits for
The FAQ released recently yields information on the Independent Dispute Resolution. The FAQs related to the No Surprises Act final rule was released last week. Just
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
EDITOR’S NOTE: CMS has published the Fiscal Year 2023 (Oct 1, 2022) final rules for Medicare payments. The major rule is, of course, the inpatient hospital
Recently, the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) released an interesting audit. They audited billing of
Lots to report in this regulatory update. Last week we heard that another major insurer is doing what one insurer did last year to a
The week of July 11 was one that was full of regulatory excitement. As expected, the U.S. Department of Health and Human Services (HHS) extended
Exceptions should be never rare nor unusual. I recently had the opportunity to participate in a discussion with colleagues who also deal on a daily
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
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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