CMS's proposed CRUSH (Comprehensive Regulations to Uncover Suspicious Healthcare) initiative signals a significant shift toward more aggressive, data-driven oversight of healthcare claims, documentation, billing practices, provider enrollment, and payment integrity. As federal agencies expand their use of analytics to identify potential fraud, waste, abuse, and improper payments, organizations face increased exposure to audits, denials, repayments, payment suspensions, and enforcement actions when documentation, coding, billing, or operational processes fail to support claim accuracy and medical necessity.

Join acclaimed documentation, coding, quality, risk adjustment, revenue integrity, and compliance leader, Penny Jefferson, as she provides a practical overview of CMS CRUSH and its potential implications across the healthcare payment lifecycle. Participants will gain insight into how organizations may be evaluated through claims patterns, documentation support, coding accuracy, medical review, provider enrollment information, and payment-integrity activities. Expert guidance will help attendees identify common vulnerabilities and develop strategies to strengthen claims defensibility and enterprise-wide program integrity.

Why This is Relevant:

With federal oversight evolving rapidly and potential rulemaking on the horizon, healthcare organizations cannot afford to wait. Understanding where risks exist today, and how to proactively address them, can help prevent costly denials, audit findings, repayments, enrollment actions, and compliance concerns tomorrow. Now is the time to prepare for a new era of healthcare oversight.

Learning Objectives:

• Understand how CMS CRUSH reflects the growing focus on data-driven program integrity and payment oversight.
• Identify organizational functions and processes most likely to be affected by CRUSH-related scrutiny.
• Recognize documentation, coding, billing, medical-necessity, and enrollment vulnerabilities that can increase audit and enforcement risk.
• Learn how the medical record serves as critical evidence across reimbursement, compliance, quality reporting, and federal oversight activities.

Who Should Attend:

Hospital executives, revenue cycle leaders, compliance officers, legal and audit leaders, HIM directors, coding leaders, billing leaders, clinical documentation integrity leaders, denials and appeals leaders, utilization review leaders, case management leaders, physician advisors, quality leaders, risk adjustment leaders, managed care leaders, finance leaders, payer relations teams, medical group leaders, ambulatory operations leaders, and clinical operations executives.