The Centers for Medicare & Medicaid Services (CMS) proposed a rule intended to reduce what it describes as excessive state payment practices, and to redirect
Once in a while, you just have to laugh. And my most recent laugh came at the expense of an unidentified Medicare Advantage (MA) plan.
Healthcare compliance has entered the machine-learning era, and most organizations have not yet noticed. Providers are using artificial intelligence (AI) to generate documentation, surface reimbursable
I realize we just covered Medicare enrollment issues a few weeks ago, but we are getting inundated with enrollment questions, problems, and most importantly, clients
I am happy to report that there is no major controversy to report on this week. So let me address issues that came up with
This month, the Secretary of the U.S. Department of Health and Human Services (HHS) – Robert F. Kennedy, Jr. – testified at seven congressional committee
Let me start with some follow-up on a topic I have written about before: the widening of the use of “against medical advice” (AMA) to
Last summer’s Loper Bright decision was supposed to be a watershed moment for administrative law. By overturning Chevron deference, the U.S. Supreme Court declared that
EDITOR’S NOTE: This morning on Monitor Monday, senior healthcare analyst Frank Cohen related how he lost an extrapolation appeal because the Administrative Law Judge (AJL)
There is no question that a proper diet is an important part of achieving and maintaining good health. But there are limits to that notion.
As we enter the first year of post-Loper Bright v. Raimando, the landmark U.S. Supreme Court decision overturning so-called Chevron deference, healthcare providers should push
It just seems that a week does not go by when an insurance company doesn’t develop a new policy that leads to confusion in the
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.
This Memorial Day, we honor those who gave all for our freedom. Take 20% off sitewide through May 29 with code MEMORIAL26 at checkout
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
