Payers and providers square off to ensure patients aren’t stuck with huge costs. EDITOR’S NOTE: Matthew Albright, chief legislative affairs officer for Zelis and the
Let’s talk targeted probe-and-educate (TPE) audits – again. I received quite a bit of feedback on my recent RACmonitor article regarding Medicare TPE audits being
Healthcare system drops petition to the U.S. Supreme Court to challenge the constitutionality of the whistleblower provisions of the False Claims Act Last month, several
Medicare Advantage Plan contracts are “take-it-or-leave-it” agreements Many questions are swirling about regarding Medicare Advantage Plan (MAP) denials asking what to do about the increasing
Major realignment is scheduled for this weekend. As reported last week by RACmonitor, in a restructuring of the Beneficiary and Family-Centered Care Quality Improvement Organization
The highest court in the land cited a failure by HHS to follow notice-and-comment obligations. In a ruling made public Monday, the U.S. Supreme Court
OIG’s report to Congress profiles plenty of activity, including the ongoing battle against the opioid abuse epidemic. The U.S. Department of Health and Human Services
CORRECTION: Because of a publishing error, this article, written by healthcare attorney David Glaser, was published on May 30 by RACmonitor after the new guidance
Allegations were made of kickbacks in the form of co-pay waivers. Late last month, US WorldMeds, a pharmaceutical manufacturer, agreed to pay the U.S. Department
The MAC is proposing an LCD for vertebral augmentation procedures. The controversy over the vertebral augmentation procedures kyphoplasty and vertebroplasty continues with a just-released proposed
A search for a national review HWDRG contractor is expected in the third quarter. In a restructuring of the Beneficiary and Family-Centered Care Quality Improvement
A Manhattan Institute senior fellow makes his case for Medicare Advantage. A prominent conservative healthcare policy expert had a simple message in a recent opinion
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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