The DOJ has focused particularly on the payment of kickbacks that induce physicians to prescribe more, or more expensive, opioids. Last week, President Trump unveiled
For one health system, staying the 340B drug program makes financial sense. Working at a large teaching hospital in Pennsylvania recently, I was able to
Questions still linger regarding specifics of implementation. By Mark Spivey Arkansas has become the nation’s third state to implement a work requirement for Medicaid, according
Hospitals must perform medical screening evaluations to patients presenting at emergency departments. Anthem Blue Cross Blue Shield, the nation’s largest health insurer, instituted a policy
All audits are questionable, contends the author, so appeal all audit results. Providers ask me all the time – how will you legally prove that
Taking a look at whether approaches that yield results in other fields could do so in healthcare, too. Sometime around August of last year, I
CMS guidance about medical review changes for inpatient rehabilitation facilities (IRF): Bonus or baggage? There has been lots of buzz about Medicare’s most recent clarifications
Clarity is badly needed for the quarterly health data report. Every quarter, the quality representatives at most hospitals receive their Program for Evaluating Payment Patterns
For implanted cardioverter defibrillators, (ICDs) there is no national coverage determination (NCD), nor is there an implementation date. As we have reported in past editions
Recent press coverage misleadingly suggested that the ruling was a serious setback to the government’s suit, which is not the case. On Feb. 12, 2018,
Uncertainty remains regarding specifics of documentation. A couple of weeks ago I talked about the new national coverage determination (NCD) for defibrillators. At the time,
Guidance on a common unbundling modifier has shifted frequently during the last decade. Anthem Blue Cross Blue Shield (BCBS) were set to implement a new
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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