The industry's trusted authority on overturning denials and payer audits — equipping providers with the expertise, resources, and community to challenge unfair practices, recover rightful revenue, and drive lasting change in healthcare reimbursement.
AHDAM speaks for the people doing the work — pushing back on payer practices that erode reimbursement, surfacing patterns across hospitals, and partnering with policy bodies to drive change.
121+ tip sheets, templates, policies, and 50 state-by-state legal snippets — searchable by denial type, payer, and clinical scenario. Two decades of practitioner-tested guidance.
Live sessions and on-demand recordings from the appeal professionals who've done it. Clinical validation. DRG downgrades. Prior auth strategy. Ask-the-experts Q&A built in.
AHDAM Appeal Management Certification — the credential that proves you can do this work. Curriculum, exam, continuing education, all in one pathway.
AHDAM is proud to announce a strategic partnership with Hyve Health. Our shared mission is to strengthen the healthcare community's ability to prevent manage, and overturn insurance denials.
HYVE brings advanced analytics and tranparency tools, like the Payer Vitality Scorecard™, empowering providers to track and respond to shifting payer behavior.
Partners →
PayerWatch is on a mission to ensure every hospital in the U.S. is fully capable of defending themselves against egregious payer behavior. That's a mission we at AHDAM can get behind!
Through sophisticated software and world-class appeal solutions PayerWatch is holding payers accountable and protecting provider revenue like no one else in healthcare today.
Partners →AHDAM is the only place I've found where the appeal letters, the legal precedent, and the people who've actually overturned these denials all live in one room.
I've written hospital appeals for 15 years. By far the most practical training I've ever taken — clinically grounded, legally informed, and immediately useful Monday morning.
The Minnesota ACDIS chapter learned an enormous amount. Conversational, candid, and packed with strategy we can deploy that day.
Founded AHDAM to put practitioner intelligence in every appeal professional's hands. Two decades in healthcare denial & appeal management.
Senior Fellow in Hospital Medicine. Leads clinical & physician-advisor programming, peer-to-peer strategy, and the certification curriculum.
AHDAM's board brings together healthcare attorneys, physician advisors, and revenue cycle leaders from health systems nationwide.
Become a member, get certified, or ask the appeal experts — three ways into the AHDAM community.
October 13, 2026
Humana will enter a joint venture with investment firm BlackRock to manage and operate its CenterWell primary care clinics for older adults, swapping out its current partner Welsh, Carson, Anderson & Stowe.
This article was originally published on Fierce Healthcare.
October 13, 2026
Another round of healthcare industry earnings reports kicked off Tuesday morning, with UnitedHealth Group reporting $4.1 billion in profit for the third quarter.
This article was originally published on Fierce Healthcare.
October 12, 2026
Two Thoreau-backed healthcare companies are partnering to bring real-time payer policy intelligence into revenue cycle workflows. The aim is to move claims denial management upstream into denial prevention, the companies said.
This article was originally published on Fierce Healthcare.
October 12, 2026
Alignment Healthcare sued federal regulators, alleging that its 2027 Medicare Advantage star ratings were determined “in flagrant violation” of statute.
This article was originally published on Fierce Healthcare.
October 9, 2026
Federal regulators released the hotly anticipated star ratings for the 2027 Medicare Advantage plan year, and winners and losers emerged in the data.
This article was originally published on Fierce Healthcare.
October 8, 2026
The Trump administration has released the 2027 Medicare Advantage star ratings, with many enrollees in plans that earned at least four stars.
This article was originally published on Fierce Healthcare.
October 8, 2026
A survey of 52 experts spanning researchers, the Medicare Advantage industry, patient advocates and policymakers wasn’t able to identify a single policy proposal that would be received wholeheartedly by all three groups.
This article was originally published on Fierce Healthcare.
Author: Ronald Hirsch, MD, FACP, ACPA-C, CHCQM, CHRI | October 7, 2026
Well, we are officially in fiscal year (FY) 2027, and the start of all the provisions of the 2027 Inpatient Prospective Payment System (IPPS) Final Rule. And that means all the hard work you did to reduce length of stay and increase your hospital’s case mix index (CMI) over the last year is out the window. Why is that?
Because Oct. 1 is when the Centers for Medicare & Medicaid Services (CMS) resets all the Diagnosis-Related Group (DRG) weights and the geometric mean length of stay (GMLOS). And because everyone is always trying to shorten length of stay and reduce costs, the data that CMS uses to reset the values each year suggests that patients are discharged sooner and cost less. Sometimes you just can’t win.
We are also approaching open enrollment season, when beneficiaries can switch their Medicare plans. They can go from traditional Medicare to Medicare Advantage (MA), switch to a different MA plan, or give up their MA plan and go back to traditional Medicare. But note that if they switch back to Medicare, they may not be able to obtain a supplement.
Because it is complex, many Medicare beneficiaries use insurance brokers to help pick a plan. And the Center for Medicare Advocacy issued a warning a couple of weeks ago that there are increasing reports of these brokers aggressively cross-selling other insurance products. The Center advises beneficiaries to ask questions, and urges them not to fall for high-pressure sales tactics. Help your family and friends who face these decisions understand their options.
The Center also issued a report on increasing number of cases of Medicare beneficiaries with a MA plan who reside in nursing facilities that disenroll them from the MA plan without their knowledge or consent. CMS first put out a notice about this in 2015, so it is not new, but it sure is unethical.
While there is no clear explanation given, one has to think that the facilities want to get patients back on Medicare Parts A and B so they can provide covered care like therapy services without having to go through the pain of getting authorization from the MA plan and having to submit notes every few days to get the authorization extended.
The Center for Medicare Advocacy is a great organization. If you are not subscribed to their free weekly newsletter, do it now.
Next, I have talked about site neutrality before. Payers want it so they don’t have to pay a hospital more for a surgery that could have been done at a lower cost to them at a surgery center or physician office. So far there is only talk in Washington. But one payer, Elevance Health, has figured out a workaround to reduce their expenditures.
They are going to start requiring that claims for services at hospital-owned facilities include the address where the service was actually provided, rather than just billing with the hospital’s information. That will allow them to adjust payment for services that were performed off-campus to the same rate they would pay an independent facility not affiliated with a hospital or health system. Just as Aetna did with their severity index plan, the payers are figuring every way they can to reduce their costs and increase their profits.
Finally, Oct. 1 marked the loss of Medicaid coverage for hundreds of thousands of immigrants who are lawfully present in the country, but do not have permanent resident status. This adds to the estimated 760,000 people who were disenrolled from their Marketplace plan by CMS a couple of weeks ago. Many of these people will end up in our hospitals needing medical care, and once again it will fall upon many of you to develop a safe and effective plan for them.
There is a bit of irony about this in that Oct. 1 also marks the start of Case Management Month, when we honor the vital contributions of case and care managers across the healthcare continuum. And I thank all of you for everything you do every day for our patients.
This article was originally published on RACmonitor.
October 6, 2026
Last month, SCAN Health Plan revealed that it would team up with Walmart to launch co-branded Medicare Advantage plans in two states. Now, the partners are offering a deeper look at how those benefits have taken shape, and why they saw potential in coming together.
This article was originally published on Fierce Healthcare.
October 5, 2026
Texas Attorney General Ken Paxton announced on Monday that he would launch an investigation into industry giant UnitedHealth Group for “engaging in deceptive and unlawful practices” that may have denied care to Texans.
This article was originally published on Fierce Healthcare.