Federal auditors have never been more focused on inpatient psychiatric care, and the stakes are enormous. Tight, highly specific rules govern admission, documentation, treatment, and discharge planning under IPF-PPS, and they now extend deep into the fast-growing Medicare Advantage population.. In one recent example, a facility treating psychiatric patients received a UPIC letter suggesting nearly $20 million in potential overpayments over just four years. Leveraging sophisticated, AI‑powered data mining to compare your claims, diagnosis patterns, admission/readmission activity and outcomes against “similar” facilities, entities like the OIG, RAs, ZPICs, CERT contractors, MACs and especially UPICs can turn even small documentation gaps into signs that your organization is a costly outlier. The result can be a frightening audit letter that appears to demand multimillion‑dollar repayments—before you have even had the chance to defend your care.

Join Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance in this intensive webcast as he gives you a clear, practical roadmap to get it right the first time, and to respond effectively if you are targeted. Michael will unpack what federal auditors are actually looking for in IPF-PPS cases and how they use data to zero in on “problem” providers. You will walk through:

• IPF admission criteria
• Certification and recertification timelines
• Documentation expectations and discharge planning requirements
• The traps and pitfalls that have already led to lost revenue
• Best practices you can implement immediately to strengthen compliance and reduce repayment risk

Why This is Relevant:

Now is not the time for a wait‑and‑see approach. Medicare Advantage enrollment has crossed the halfway mark of all Medicare beneficiaries, and those plans are required to follow traditional Medicare rules while layering on their own preauthorization and medical‑necessity criteria. At the same time, UPICs have emerged as some of the most aggressive auditors in the field, armed with tools that can turn routine claim patterns into high‑dollar investigations. Getting ahead of these trends—by tightening documentation, hard‑wiring compliant processes and understanding the “hot spots” in IPF-PPS—can be the difference between a manageable review and a devastating repayment demand. Attending this webcast now positions your organization to reduce exposure, protect revenue and respond confidently when scrutiny comes.

Learning Objectives:

After attending, you’ll be able to:

• Understand federal IPF-PPS requirements for admission, treatment and EMR documentation, including certification and recertification timelines and other essential elements of a defensible inpatient psych stay.
• Identify the most frequently reported MS‑DRGs and diagnosis patterns that trigger inpatient psych audits, and why auditors focus so heavily on this data.
• Recognize additional aspects of IPF cases that OIG, UPICs, CERT and other federal auditors scrutinize, and how those findings should inform your internal review priorities.
• Spot common traps and pitfalls in serial admissions and real‑world case scenarios that have been deemed “inadequate” for inpatient psychiatric admission.
• Describe the basic architecture of CMS reimbursement for IPF-PPS, including additional reimbursement for ED care, ECT and other medical services, and the key information that must be captured and reported to secure appropriate Medicare and Medicare Advantage payment.

Who Should Attend:

C-Suite (CFO, CEO, COO), Legal Teams, Compliance, Revenue Cycle, Financial Services, Billing Managers, Inpatient Psychiatry, Emergency (ER) physicians, Case Management and Utilization Review staff; Quality Assurance, HIM, RAC Audit teams, QIO Audit Teams, CDI Specialists