Join Day Egusquiza, President of AR Systems Inc., as she shares her expertise on effectively responding to Medicare Advantage denials by leveraging regulations to confidently reject unjust claims and support your rationale.
Medicare Advantage plans continue to present challenges with frequent denials, downgrades, and disputes—the "3 D's." It’s time to shift from a reactive stance to a proactive approach by mastering the regulations and turning denials into actionable strategies. Join Day Egusquiza, President of AR Systems Inc., as she shares her expertise on effectively responding to Medicare Advantage denials by leveraging regulations to confidently reject unjust claims ...
This anonymized case study highlights how we helped an international healthcare company transform its internal audit processes. How? By implementing efficient information-sharing solutions and streamlining audit practices. Company background An international healthcare company headquartered in the U.K. served over 38 million customers. It employed 84,000 people worldwide. Its mission? Improve lives by ensuring people live longer and better than before while making the world a ...
How well-equipped is your compliance program to handle the unpredictable shifts in the healthcare landscape? To help answer this pressing question, Richard Kusserow, CEO of Strategic Management Services, and former DHHS Inspector General recently shared results of a 2024 benchmark survey about the current state of healthcare compliance programs. This annual survey provides valuable insights into the challenges and trends shaping the compliance landscape. Challenges Facing ...
Open Payments, mandated by the Affordable Care Act, require certain industries to report payments and other transfers of value to healthcare providers. Open Payments remain a key focal point now for ethics, governance, risk management, and compliance leaders. Namely, the expansion of the Open Payments Data to include other healthcare providers—in addition to physicians—has significantly enhanced the transparency available to your organization and the public. This ...
Traditional Medicare’s Two-Midnight Rule is a guideline used in the U.S. healthcare system specifically for Medicare billing. It helps determine whether a patient's hospital stay should be billed as inpatient or outpatient care. This rule was designed to clarify hospital admissions criteria and plays a critical role in healthcare reimbursement, impacting institutions' operational and financial dynamics nationwide. According to this rule, if doctors expect a ...
Read our 2024 HIPAA Benchmark Report
For the fifteenth year in a row, SAI360 partnered with Strategic Management Services to study the state of healthcare compliance programs in an industry benchmark survey of programs in the United States. This annual survey is designed to gain an understanding of issues currently confronting compliance programs and how compliance officers and organizations are responding to them. In this webinar, former HHS Inspector General, Richard ...
In this webinar, former HHS Inspector General, Richard Kusserow, CEO of Strategic Management Services, reports on the results and provides analysis of the data from the survey, including important trending and cumulative data from prior years.
Live webinar: Tuesday, April 30 1:00 PM ET | 12:00 PM CT | 10:00 AM PT For the fifteenth year in a row, SAI360 partnered with Strategic Management Services to study the state of healthcare compliance programs in an industry benchmark survey of programs in the United States. This annual survey is designed to gain an understanding of issues currently confronting compliance programs and how compliance officers and ...
