The proposed changes target the federal Physician Self-Referral Law and the Anti-Kickback Statute. The U.S. Department of Health and Human Services (HHS) is introducing proposed
Although capped, more plaintiffs are expected to be included in a second lawsuit. EDITOR’S NOTE: Virginia Gov. Ralph Northam, along with six managed care organizations
AI presents an entirely new landscape for defense against audits. The Trump administration has launched a program to employ artificial intelligence (AI) in Medicare audits.
Physicians are sure to bristle at a perceived push toward non-physician practitioners operating more independently. EDITOR’S NOTE: President Donald Trump last Thursday signed an executive
As a Medicare/Medicaid healthcare provider, you have a property right to your reimbursements for services rendered that were medically necessary. Why does it matter if
The nonprofit news service alleges the federal government violated the Freedom of Information Act by refusing to disclose documents reflecting risk adjustment validation data. Kaiser
To understand the difference it is helpful to know the regulatory hierarchy. Last week’s article describing how Local Coverage Determinations (LCDs) are not binding prompted
Noridian uses scenarios for the parenteral administration of iron in non-dialysis patients. The Noridian iron infusion Local Coverage Determination (LCD) is important for just about
More than two dozen providers are listed as plaintiffs, with more expected to join. More than two dozen Virginia behavioral healthcare providers have filed
An ad campaign opposing the move is raising eyebrows nationwide. We’re more than halfway into September, but if you’re like me, it feels like 2019
Two recent studies indicate more can be done by providers and payers. The healthcare industry continues to devote ample attention to the social determinants of
Direct verbal communication between referring and consulting physicians is the best practice. Communicating in the chart, while convenient and useful, rarely provides the most accurate
Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
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