Since January, both President Trump and Republican leaders in Congress have talked about a three-step process for repealing and replacing the Patient Protection and Affordable Care Act (ACA). While the first six months of the Trump administration has seen mixed results, its efforts to reign in or hold back regulations, combined with its delay in filling lower-level agency roles, has impacted regulatory review and issuance of new regulations. So, despite Congress’ inability to pass legislation to change parts of the ACA, there is still plenty for providers to be concerned about.

Intent is a critical element examined in both civil and criminal healthcare fraud investigated by the government.

Long Term Care (LTC) organizations and the integrated delivery networks to which they belong are now challenged to escalate regulatory compliance—particularly in the area of Information Security—to the same priority level as Patient Safety and Quality.

Managing regulatory and compliance risk in the face of constantly evolving rules and guidelines is a significant challenge for both payers and providers, creating a pressing need for a best-in-class system to consistently support regulatory, reimbursement and compliance professionals in healthcare.

HIM professionals now engage across the healthcare enterprise, including ambulatory, acute, and postacute settings, thanks to their necessary involvement in implementing CMS' risk adjustment and Hierarchical Condition Category (HCC) coding system.