Watch Two-Midnight Rule Nightmares? Let’s talk scenarios, challenges, and Medicare Advantage denials (Video)

  In this webinar health care reimbursement and operations expert Day Egusquiza unpacks the Two-Midnight Rule, explores key elements of traditional Medicare, and delves into distinct facets of the Two-Midnight Rule (2MN) – Presumption and Benchmark. Day Egusquiza brings over 40 years’ experience in health care reimbursement, including 20 years in an Idaho hospital leading hospital revenue cycle operation, contracting, new program development, auditing and ...

Prime Therapeutics Puts Compliance at its Core with SAI360

Case study at-a-glance Prime Therapeutics provides pharmacy benefit management services for health plans, employers and government programs. It is collectively owned by 19 Blue Cross and Blue Shield plans, subsidiaries, or affiliates of those plans. It manages the entire administrative lifecycle of pharmacy benefits, from when a member is given a prescription to when a pharmacy fills it. Ryan Sloneker is the Compliance Systems & ...

Envision the Future of your Compliance Atlanta Customer Event

SAVE THE DATE: Wednesday, October 26th, 2023 11:30 AM - 1:30 PM ET SAI360 is hosting a meeting of the minds, in person in Atlanta (meeting space TBD) on October 26 from 11:30-1:30 PM CT where we will Envision the Future of your Compliance (C360) Program. Come meet other SAI360 client peers while sharing ideas and solutions in a safe, friendly, and informal space. Lunch ...

By |2025-05-07T16:52:31+00:00October 4th, 2023|Compliance, Healthcare GRC|

Two-Midnight Rule Nightmares? Let’s talk scenarios, challenges, and Medicare Advantage denials

Live webinar: Tuesday, November, 14​ Time: 1:00 PM ET | 12:00 PM CT | 11:00 AM PT Medicare Advantage (MA) plans are gearing up to implement the Two-Midnight Rule, necessitating a fresh perspective on securing inpatient status. Join health care reimbursement and operations expert Day Egusquiza to understand the Two-Midnight Rule, explore key elements of traditional Medicare, and delve into distinct facets of the Two-Midnight Rule (2MN) ...

DentaQuest Maintains Clear Checkups with SAI360

Case study at-a-glance DentaQuest, a Sun Life company, is a purpose-driven oral healthcare company dedicated to improving the oral health of all. DentaQuest manages dental and vision benefits for 30+ million Americans and provides direct patient care through a network of more than 80 oral health centers in six states. DentaQuest provides outcome-based, cost-effective dental solutions for Medicaid and CHIP, Medicare Advantage, small and large ...

8 Ways Technology Creates Agile Provider Compliance Work Plans

Healthcare compliance executives are constantly challenged to stretch limited resources when executing a compliance work plan. Those looking for a path to better efficiency and effectiveness will find the answer lies in using healthcare compliance software solutions as a tool across every work plan stage. When building a provider compliance work plan, you need smart, well-designed compliance software. This will simplify your job and improve organizational effectiveness. ...

By |2025-04-28T02:12:42+00:00February 22nd, 2023|Compliance|

IT Risk Management for Compliance: The Blueprint for an Effective, Efficient & Agile IT Risk Management Program

A GRC 20/20 by Design Workshop When: Wednesday, November 2, 2022 | 12 - 5 PM ET Where: Tampa Marriott Water Street in Tampa Bay, FL Risk and compliance professionals are under enormous pressure to guide and manage digital transformation while navigating a dramatically changing ecosystem and economy. Organizations are dealing with rapid technology adoption, distributed ways of working in the post-Covid world, new vulnerabilities, ...

By |2022-10-04T13:00:06+00:00October 4th, 2022|SAI360|

Preparing for Chicago’s New Sexual Harassment Training Requirements 

On April 27, 2022, the city of Chicago enacted additional measures to help protect individuals from sexual harassment. The changes include significant new requirements for employers related to mandatory trainings, written policies, and recordkeeping. The ordinances also revised what constitutes sexual harassment, extended the reporting and notification period, and increased monetary penalties for violations. KEY POINTS FOR COMPLIANCE: The modified ordinance became effective on July ...

By |2025-05-08T21:44:12+00:00July 21st, 2022|Ethics & Compliance Learning, SAI360, Sexual Harassment|