Last week, the Centers for Medicare & Medicaid Services (CMS) released its 2026 Budget Request and Justification to Congress, asking for $2.288 billion. I will
During my time as a physician advisor and clinical leader over the past decade – spanning four presidential administrations – I have never seen such
Skilled Nursing Facilities (SNFs) have special audits – or, should I say, more robust audits. We all know that in March 2020, both The Joint
If one judges by statistics and performance scorecards alone, in the United States, healthcare means high cost and low quality. The expenditures are enormous. Healthcare
As required by their Statement of Work, Livanta, the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) for regions 2, 3, 5, 7, and 9,
On July 23, the Centers for Medicare & Medicaid Services (CMS) issued the Final Rule for Inpatient Rehabilitation Facilities (IRFs) that updates payment policies and
While most observers of the Centers for Medicare & Medicaid Services (CMS), the release Wednesday of its final payment rule for inpatient and long-term care
Let me start today with some sad news many of you may have caught wind of last week. A Tennessee orthopedic surgeon was shot dead
There has been lots of healthcare news in the past two weeks. First, I hope all of you read my RACmonitor e-news article from July
Last October, I appeared on Monitor Mondays to examine a Centers for Medicare & Medicaid Services (CMS) proposal to develop a single, national provider directory,
On April 10, 2023, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2024 Medicare hospital inpatient prospective payment system (IPPS)
The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule for Inpatient Rehabilitation Facilities (IRFs) that would update payment policies for 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.
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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