Patients “managed” out of benefits on Medicare Advantage programs. Administrative overhead for Medicare fee-for-service operations typically runs at approximately 2-3 percent. Overhead for commercial insurance
CMS squeaks by with B-plus in OIG audit. If the Centers for Medicare & Medicaid Services (CMS) received a grade for its audit performance during
Explosive allegations revealed in Massachusetts AG lawsuit. Massachusetts is one of 36 states suing Purdue Pharma, maker of the addictive opioid pain medication OxyContin, for
MAC to audit physicians who prescribe opioids. It is well-known to the medical community and to the general public that the opioid epidemic has taken
“Non-essential” services are healthcare data services upon which providers come to rely. EDITOR’S NOTE: A second government shutdown remains a possibility if a group of
Controversy Swirls: Payers vs Providers EDITOR’S NOTE: Attorney David Glaser reported this story live on Monitor Monday today. That statement may appear to be somewhat
Medicare Advantage (MA) plans are supposed to follow the two-midnight rule. EDITOR’S NOTE: Attorney David Glaser reported this story live on Monitor Monday today. That
Expect more changes to come for provider-based clinics. There has been much federal oversight activity regarding provider-based clinics of late. For those of you that
E&M changes, opioid crisis among issues profiled in the following forecast As the commentators who predicted that the Segway would revolutionize travel well know (you
Initial round of audits proves successful for therapy providers. Therapy providers in the Novitas JL jurisdiction have received good news on the initial round of
CMS to launch new Patient-Driven Payment Model October 2019. The Centers for Medicare & Medicaid Services (CMS) was tired of paying too much for care
Errors persist in another communication on a key knee procedure. Sixteen days after the original MLN Matters publication titled “Total Knee Arthroplasty (TKA) Removal from
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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