Supreme Court Issues Landmark FCA Ruling
Knicole C. Emanuel Esq.
June 7, 2023
The U.S. Supreme Court ruled on a False Claims Act (FCA) case last week. As you probably know, the FCA makes it illegal for a
The U.S. Supreme Court ruled on a False Claims Act (FCA) case last week. As you probably know, the FCA makes it illegal for a
While ChatGPT has entered American culture and lexicon as quickly as the latest TikTok trend or Taylor Swift hit, how it will work long-term in
While we wait to see if Congress will sign off on an agreement the President and the Speaker of the House negotiated as a way
As part of the COVID-19 Public Health Emergency, or PHE, which officially ended earlier this month, the federal government gave healthcare providers considerable flexibility to
In March, the U.S. District Court in the Northern District of Texas vacated the requirement that Patient Protection and Affordable Care Act- (PPACA)-compliant health plans
Last week, the Centers for Medicare & Medicaid Services (CMS) gave itself a very bad report card on how it did during the first year
Last October, I appeared on Monitor Mondays to examine a Centers for Medicare & Medicaid Services (CMS) proposal to develop a single, national provider directory,
Defendant chains are accused of fudging their “usual and customary” rates for some drugs. Back in mid-January, the U.S. Supreme Court granted certiorari in two
The drug data report is a requirement of the No Surprises Act. The No Surprises Act (NSA) requires the collection and reporting of the prescription
Recent court ruling casts a spell of uncertainty. Texas courts have proven to be a common battleground for several federal healthcare initiatives lately- and the
A few weeks ago, the director of the federal Center for Medicaid and CHIP (Children’s Health Insurance Program) Services noted that “the return of Medicaid
Skyrocketing rates of improper payments have coincided with historically rapid enrollment in the MA program. It was a Centers for Medicare & Medicaid Services (CMS)
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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