Wednesday, September 23, 2026 | 1:00pm-2:30pm EDT
Effective November 15, 2025, major national Medicare Advantage payers adopted severity-based inpatient payment policies—approving urgent and emergent inpatient stays without medical necessity review, paying them at observation-comparable rates, and granting full inpatient reimbursement only after passing post-service severity reviews. This practical webinar equips appeal professionals with the regulatory and operational tools to combat these payment downgrades using CMS-4208-F. Learn how to distinguish contractual payment disputes from adverse organization determinations, leverage CMS limits on reopening approved admissions, and apply proven appeal strategies through step-by-step overturned case presentations.
Learning Objectives: Upon completion of this activity, participants will be able to:
- Outline the structure of severity-based inpatient payment downgrades across Medicare Advantage plans.
- Explain CMS-4208-F limits on reopening approved inpatient admissions post-service.
- Apply CMS regulations to overturn severity-based payment downgrades.