While attending the Florida Compliance and Privacy Consortium meeting, I was asked an excellent question. What if a patient who is ready for discharge from
A recent analysis of 5 billion claims from a sampling of providers found that total at-risk dollars from payer audits were five times higher in
Well, I gave you all a break from my criticism of insurance company policies and ploys last week, and I had planned to go for
If you are just crawling out from under a rock, note that last week, we had an election in this country. Republicans won the White
With a week off, I have much to report today to catch up. First, many of you may have heard or read that Medicare has
With just over a week left before the 2024 U.S. presidential election, reproductive rights have taken center stage as a critical issue for voters. The
The Eleventh Circuit Court of Appeals has ruled that a lower court made a significant misstep by excluding crucial evidence in a case involving a
Here are some important Health Insurance Portability and Accountability (HIPAA) reminders and updates. First, on the Security Rule side of things: this past Thursday, the
Cherry Hill, New Jersey is a township not far from the Delaware River, near Philadelphia. Cherry Hill is one of the Delaware Valley’s main commercial centers, with a
Healthcare providers participating in the Medicare and Medicaid programs face an intricate web of regulations and enforcement actions. Disputes with state officials over payment practices,
Readers last week surely noted my coverage of a few of the key regulatory initiatives the Biden Administration intends to undertake during the last part
As my colleague Matthew Albright reported a few weeks ago, the upcoming election may have slightly less of an impact on the business of healthcare
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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