An interview with a subject matter expert sheds light on one of healthcare’s trendiest topics. Editor’s Note: Ellen Fink-Samnick is a member of the RACmonitor
Hot topics come and go – and healthcare is no exception. A few years ago, predictive analytics (PA) was making its rounds, and I remember
Coverage would include those suffering from chronic lower back pain who are also enrolled in approved studies. The Centers for Medicare & Medicaid Services (CMS)
Swing vote by Chief Justice John Roberts reflects his support of judicial precedent. On June 26 the U.S. Supreme Court issued a decision (https://www.supremecourt.gov/opinions/18pdf/18-15_9p6b.pdf) on
Coding Guidelines and Conventions trump Coding Clinic. Hats off to coders. This group of medical information professionals is required to master one of the most
Case is centered around Level 2 and Level 3 E&M encounters. This past week, I received a call from an older physician who has been
With a sea of SDoH reports, what will it take to yield change? America’s Health Insurance Plans (AHIP) recently announced its newest initiative, Project Link.
Mental health represents the latest dimension of the SDoH. EDITOR’S NOTE: This topic was covered by Ms. Fink-Samnick during her featured appearance on the most
OMHA’s new eligibility requirements are intended to benefit more providers. The Office of Medicare Hearings and Appeals (OMHA) has expanded its Settlement Conference Facilitation (SCF)
Work requirements appear to be ineffective. At present, 37 states and the District of Columbia have passed Medicaid expansion. All 50 states may not agree
This case of goes beyond DSH payments. Earlier this month the U.S. Supreme Court decided an appeal brought by Allina and many other hospitals challenging
Understanding why there’s a need for auditing the auditors. I frequently encounter complaints by healthcare providers that when they are undergoing Recovery Audit Contractor (RAC),
Medicare regulations are complex and even seasoned professionals struggle to apply them consistently. Due to overwhelming demand, Dr. Hirsch returns for Part 2 of Ask Dr. Hirsch: Clarifying Medicare’s Most Misunderstood Rules to answer even more of Medicare’s most misunderstood questions, covering inpatient status, observation, SNF access, Medicare Advantage denials, and more. Join Dr. Hirsch as he provides clear, referenced answers to real-world questions submitted by your peers, helping you navigate Medicare compliance with confidence and clarity.
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.
Artificial intelligence is rapidly transforming healthcare revenue cycle operations, from coding and auditing to compliance and denials. Join industry leaders Pam Warren (MaineHealth) and Raemarie Jimenez (AAPC) for a live fireside chat exploring how AI is changing workflows, workforce roles, payer-provider dynamics, and compliance risk—and what organizations should be doing now to prepare.
Prepare for FY 2027 IPPS changes with a comprehensive 3-part masterclass covering ICD-10-CM/PCS updates, MS-DRG shifts, NTAPs, compliance risks, and reimbursement strategies.
Stay ahead of FY 2027 reimbursement changes with expert analysis of MS-DRG shifts, NTAP updates, Medicare Code Edits, and emerging technologies impacting inpatient payment accuracy.
Stay ahead of FY 2027 ICD-10-PCS changes with expert analysis of new procedure codes, revised guidelines, and high-impact updates affecting reimbursement, compliance, and inpatient coding accuracy.
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