A highly publicized UHC denial of care led to more questions than answers. By now many have read the ProPublica expose on how UnitedHealthcare (UHC)
Proposed rule calls amending regulations clarifying the determination as to whether a physician qualifies as a rehabilitation physician is made by the IRF. The Centers
Initial round of audits proves successful for therapy providers. Therapy providers in the Novitas JL jurisdiction have received good news on the initial round of
Military healthcare program expanding coverage following extensive lobbying campaign. The U.S Department of Defense has signaled the start of the process to authorize physical therapist
IRFs can breathe easier; no change in policy. CMS has clarified the question of counting minutes of therapy provided by students. The Inpatient Rehabilitation Facility
A brewing problem, or simply an area for clarification for IRFs? During what was expected to be a plain vanilla review of the Inpatient
CAR-T therapy could list a single service with a $1.4 million charge. I was honored to be able to speak at the annual meeting of
Legislation establishes the 2018 therapy cap level of $2,010 as a threshold level. The therapy caps have been eliminated! It has been a long and
Those involved in compliance will want to keep tabs on these changes with due concern. The Bipartisan Budget Act of 2018 (BiBA) was signed into
At the heart of underusing palliative care is that no person wants to inflict sadness on another. Among the synonyms for the adjective ‘brutal’ are
She had chosen palliative care as the medical therapy. EDITOR’S NOTE: Former First Lady Barbara Bush died Tuesday at age 92 at her home in
Pending a possible government shut down, this bill would allow documentation from a home health agency to be considered when records are reviewed. Late on
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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