Are MACs going rogue? According to a webinar held last week, NGS, the Medicare Administrative Contractor (MAC), has taken the targeted probe-and-educate audits (TPE) to
CMS report is based on 2016-2017 data. It’s been two years since the American Hospital Association (AHA) shouted from the rooftops that documentation by any
CMS launches healthcare outcomes challenge. Expect more artificial intelligence (AI) in healthcare in 2020. We will see AI used primarily in diagnostics and auditing. In
The OIG has instructed MACs to recoup the entire DRG payment on claims dating back to 2016. EDITOR’S NOTE: The RACmonitor special bulletin of Jan.
At issue: hospital overpayments of $54.4 million. There has been recent talk on an online user group that many hospitals have had recoupments of payment
The audit environment is unlikely to improve. On Monday, Jan. 14, the Monitor Mondays panel of experts came together to celebrate the 10th anniversary of
Physicians urged to monitor all upcoming developments regarding this new issue. The debate over percutaneous vertebral augmentation is continuing in 2020, with the release of
New white paper addresses behavioral healthcare in the ED and the SDoMH The social determinants of health (SDoH) are on everyone’s watch list, but attention
Often overlooked is the line-item price reduction step, particularly related to partial or 50 percent-or-greater credits. It was inevitable: just when hospitals were getting comfortable
The absence of a physician’s signature should not result in denial of a Medicare claim. As a regulatory and compliance officer, I often have the
CMS’s IMM sends mixed messages to providers. The Important Message from Medicare (IMM) has changed significantly in its latest reiteration, and the IMM now must
Report provides a sobering look at human hardships. A new report from the Robert Wood Johnson Foundation, NPR, and Harvard T.H. Chan School of Public Health was
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.
Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
This third session in our 2026 IPPS Masterclass will feature a review of FY26 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.
This second session in our 2026 IPPS Masterclass will feature a review the FY26 changes to ICD-10-PCS codes. This information will be presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.
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