Description

Healthcare providers are facing increasing scrutiny as Medicare and Medicaid compliance requirements continue to evolve in 2026. New Medicare Advantage regulations, enhanced documentation expectations, stronger behavioral health protections, growing Special Needs Plan (SNP) enrollment, and continued CMS oversight have made compliance more important than ever. Providers who fail to maintain proper documentation, billing integrity, and compliance protocols face greater risks of audits, payment denials, overpayment recoveries, and fraud investigations. 

This practical webinar provides healthcare professionals with a comprehensive understanding of Medicare and Medicaid compliance requirements while incorporating the most important 2026 regulatory and operational updates affecting provider practices. Participants will learn the differences between Original Medicare, Medicare Advantage, and Medicaid, along with current documentation standards, billing compliance fundamentals, audit prevention strategies, and fraud prevention best practices.

Special attention will be given to Medicare Advantage compliance, including documentation expectations, behavioral health coverage changes, risk areas, and the growing role of Special Needs Plans (D-SNPs and C-SNPs). The session will also review proper record retention, HIPAA documentation, billing integrity, and practical compliance workflows that reduce organizational risk while improving patient care.

Through real-world examples, compliance scenarios, and implementation strategies, attendees will leave with practical tools they can immediately apply to strengthen documentation, improve billing accuracy, prepare for audits, and maintain ongoing Medicare and Medicaid compliance throughout 2026.

Learning Outcomes

• Understand Medicare and Medicaid compliance requirements and recent 2026 regulatory updates. 
• Distinguish Original Medicare, Medicare Advantage, and Medicaid coverage requirements. 
• Identify documentation standards required to support compliant billing and medical necessity. 
• Apply Medicare Advantage documentation and compliance requirements in daily practice. 
• Recognize common audit triggers, billing errors, and fraud risk indicators. 
• Develop documentation and record-retention practices that support audit readiness. 
• Understand compliance considerations for behavioral health services, Special Needs Plans, and coordinated care. 
• Implement billing compliance strategies that reduce denials, overpayments, and reimbursement risk. 
• Build practical compliance workflows that strengthen organizational policies and staff accountability. 
• Prepare for CMS audits and investigations using proactive compliance and risk management strategies.

Areas Covered in the Session

• Medicare: Federal Health Insurance Program
  • Part A: Hospital Insurance
  • Part B: Medical Insurance
  • Part C: Medicare Advantage Plans
  • Part D: Prescription Drug Coverage
• What's New in Medicare Advantage for 2026
  • Behavioral health cost-sharing updates
  • Medicare Prescription Payment Plan (MPPP)
  • Current Medicare Advantage compliance priorities
  • Out-of-pocket and Part D benefit changes affecting providers
• Medicare Advantage Growth & Special Needs Plans (SNPs)
  • D-SNPs
  • C-SNPs
  • Why providers need to understand growing SNP enrollment
  • Care coordination and documentation considerations
• Medicaid Fundamentals
  • Federal-State partnership
    • Income-based eligibility
    • State-specific requirements
  • Eligibility requirements
  • Mandatory vs optional benefits
  • State-specific program differences
• Medicare vs Medicaid Compliance Requirements
• Documentation Compliance Essentials
  • Medical necessity
  • Time-based documentation
  • Required clinical documentation
  • Documentation supporting billing accuracy
• Billing Compliance Fundamentals
  • Coding accuracy
  • Documentation-to-billing consistency
  • Preventing billing errors
  • Risk adjustment documentation awareness
• Audit Readiness and Fraud Prevention
  • Common CMS audit triggers
  • Red flags that increase compliance risk
  • Fraud, Waste, and Abuse (FWA) prevention
  • Internal audit best practices
• Record Retention & HIPAA Compliance
  • HIPAA documentation
    • HIPAA Records
    • Medicare/ Medicaid Records
  • Medicare and Medicaid record retention
  • Electronic Health Records (EHR)
  • Hybrid and paper documentation systems
• Required Compliance Documentation
  • Initial patient documentation
  • Ongoing service documentation
  • Financial documentation
  • Staff education records
  • Compliance program documentation
• Essential Compliance Policies
  • Privacy policies
  • Security risk assessments
  • Business Associate Agreements
  • Policy and procedure documentation
• Medicare Advantage Operational Best Practices
  • Prior authorization documentation
  • Behavioral health documentation
  • Care coordination records
  • Compliance workflow improvements
• High-Risk Compliance Areas
  • Documentation deficiencies
  • Billing inconsistencies
  • Duplicate services
  • Medical necessity concerns
• Practical Compliance Implementation Checklist
  • Daily compliance habits
  • Internal monitoring
  • Staff education
  • Continuous quality improvement
• Interactive Q&A Session with Gabrielle Juliano-Villani

Recommended Participants

• Mental Health Providers 
• Behavioral Health Clinicians 
• Physicians 
• Nurse Practitioners 
• Physician Assistants 
• Clinical Social Workers 
• Licensed Professional Counselors 
• Psychologists 
• Medical Practice Administrators 
• Medical Office Managers 
• Revenue Cycle Managers 
• Medical Billing Specialists 
• Medical Coders 
• Healthcare Compliance Officers 
• Clinical Documentation Improvement (CDI) Specialists 
• Case Managers 
• Care Coordinators 
• Quality Improvement Professionals 
• Group Practice Owners 
• Ambulatory Care and Outpatient Clinic Managers