As we conclude National Case Management Week 2025 with the theme of “Guiding Journeys,” we are making a point of celebrating case management professionals who lead with heart, expertise, and purpose!
During this week’s festivities, Mary Beth Pace will share how the work of the professional case manager is getting harder, as the patients and families we journey beside are dealing with an ever-more costly, complex, and fragmented healthcare system.
Patients as consumers are struggling to juggle household discretionary spending. The latest data we have is from August, due to the federal government shutdown. It shows that healthcare expenditures account nationally for 8.3 percent of the monthly consumer price index, or CPI.
In the last 12 months, the overall CPI increased 2.9 percent. However, the healthcare services portion increased 4.2 percent, the largest percentage increase relative to housing, food, and energy costs. Individuals are truly feeling this, as average wage growth is only between 1 and 1.2) percent. This is critical information to digest as we prepare for the potential loss of marketplace subsidies and escalating insurance premiums that can only mean households will be spending more for healthcare.
As you may be aware, on July 4, the President signed into law a budget reconciliation bill, the One Big Beautiful Bill Act (OBBBA). The bill included significant policy changes to Medicaid and the Health Insurance Marketplaces. The Congressional Budget Office (CBO) score indicated that the OBBBA will lead to nearly $1 trillion in Medicaid cuts, and could result in roughly 12 million people losing Medicaid and health insurance coverage. The CBO also stated that changes to state-directed payments (SDPs) and providers’ taxes is expected to save the government $340 billion, leading to drastic payment cuts to hospitals. According to one analyst, employer health plan enrollment could rise by 3.2 million if Congress lets federal subsidies for individual coverage expire. In addition, unless extended, the Patient Protection and Affordable Care Act (PPACA) subsidies expiration will cause, on average, a 114-percent increase in premiums for 2026.
Multiple projections have the number of uninsured people nationwide rising to 28 million, a 21-percent increase.
This bill, absent any updates on expiring programs, including Disproportionate Share Hospital (DSH) cuts, telehealth and Hospital at Home will significantly impact hospitals and physicians in Medicaid expansion and non-expansion states.
We are already seeing substantial impact with the shutdown, as Congress and the President struggle to find a compromise that extends federal program legislation. In the meantime, states will soon be dipping into contingency funds to keep basic programs like Women, Infants, and Children (WIC) flowing to those who depend on them. As for telehealth and Hospital at Home, popular programs included in the current continuing resolution, we are in a holding pattern, with the Medicare Administrative Contractors (MACs) directed on Oct. 1 to place a 10-day hold on telehealth payments to avoid reprocessing, in case Congress restores the pre-pandemic flexibilities that expired Sept. 30.
Add on to this the deep cuts to research funding, and directional changes at the U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS), healthcare systems are making daily decisions about funding existing programs and future growth strategies. All of this creates uncertainty for providers, employers, and individual consumers. It is in this current climate that case management teams, who are already dealing with increasingly difficult families and decreasing local resources, will see exponentially more challenges in developing safe and effective discharge plans.
Hotly anticipated performance targets and payment amounts for the Centers for Medicare & Medicaid Services (CMS) Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model
I often begin my day with an environmental scan. Last week, an article from Becker’s Clinical Leadership caught my eye, “Hospital mortality, infectionrates improve despite
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Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s third quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s second quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
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.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
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