revenue integrity Archives

2026 Healthcare Compliance: Navigating Medicare RAC Audits with Confidence

Executive Summary: As we approach the middle of 2026, the Centers for Medicare & Medicaid Services (CMS) is intensifying its focus on improper payments through expanded Medicare RAC oversight. Regulators are increasingly using AI and predictive analytics to flag claims. For hospital Chief Compliance Officers, relying on manual, periodic checks is no longer viable. Hospitals must adopt AI-powered healthcare compliance software to continuously monitor data, automate the RAC audit process, and build a defensible compliance posture. The 2026 Regulatory ...

By Charlotte Yatsko|2026-05-13T16:30:15+00:00May 13th, 2026|blog|

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

Medicare Advantage (MA) plans are gearing up to implement the Two-Midnight Rule, necessitating a fresh perspective on securing inpatient status. 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. This session includes real-world denials scenarios, offering practical insights into ...

By SAI360|2025-05-07T17:57:45+00:00November 15th, 2023|Governance, Risk & Compliance: GRC, Healthcare GRC, Healthcare Revenue Integrity|

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 SAI360|2025-04-28T02:12:42+00:00February 22nd, 2023|Compliance|

How Do You Reduce Healthcare Revenue Leaks?

In this second blog in our Managing Revenue Risk series, Marcy Andersen, Director, Account Management at SAI360, discusses healthcare revenue leaks and how an automated workflow goes beyond simple work queues to support collaboration and effectiveness in payer audits and the denial appeal process. Healthcare revenue leakage is a moving target, thanks to fluctuating payer rules and the complexity of the denial and audit processes. ...

By SAI360|2025-04-28T02:09:46+00:00November 30th, 2022|Compliance, Healthcare Revenue Integrity|

Top Payer Audit and Denial Challenges and Strategies for Success – It’s All About the Money

Our experts discuss the multiple at-risk areas that healthcare providers are currently managing, navigating, and addressing daily.

By SAI360|2022-06-07T22:50:14+00:00June 7th, 2022|Healthcare GRC|

Top Payer Audit (& Denial) Challenges and Strategies for Success – It’s All About the Money!

Our experts discuss the current healthcare compliance landscape, with a dedicated focus on Medicare Advantage and audit hot spots.

By SAI360|2025-05-14T13:11:07+00:00April 20th, 2022|Compliance|

Prior Authorizations: Problems When in the Wrong Hands

Marcy Andersen was a featured guest on the Monitor Monday podcast to discuss Recovery Auditors and the prior authorization process.

By SAI360|2022-03-14T17:27:15+00:00March 14th, 2022|Compliance|

Healthcare Compliance Programs: 2021 Benchmark Survey Results

In collaboration with Strategic Management Services, we analyzed the results of our annual Healthcare Compliance Benchmark National Survey, looking for new trends in managing risks.

By SAI360|2025-05-06T15:16:25+00:00February 3rd, 2022|Compliance, Healthcare Revenue Integrity|

2020 HIPAA Compliance Benchmark Report (pdf)

This report summarizes the findings from the 2020 National HIPAA Compliance Benchmark Survey conducted by SAI360 and Strategic Management Services.

By SAI360|2025-04-28T22:03:10+00:00January 13th, 2022|Governance, Risk & Compliance: GRC, Healthcare GRC, Healthcare Revenue Integrity|

Cyber Threat Alert: Coronavirus Scams Hit the U.S. Healthcare Industry

Read about the latest threats along with tips for Compliance and Privacy Officers to keep your organization safe from scammers during these trying times when guards are down and fears are heightened.

By SAI360|2025-05-09T19:58:35+00:00April 3rd, 2020|Compliance|

2026 Healthcare Compliance: Navigating Medicare RAC Audits with Confidence

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

8 Ways Technology Creates Agile Provider Compliance Work Plans

How Do You Reduce Healthcare Revenue Leaks?

Top Payer Audit and Denial Challenges and Strategies for Success – It’s All About the Money

Top Payer Audit (& Denial) Challenges and Strategies for Success – It’s All About the Money!

Prior Authorizations: Problems When in the Wrong Hands

Healthcare Compliance Programs: 2021 Benchmark Survey Results

2020 HIPAA Compliance Benchmark Report (pdf)

Cyber Threat Alert: Coronavirus Scams Hit the U.S. Healthcare Industry

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