A landmark Supreme Court decision is a game-changer in this area. After my last segment on Monitor Mondays, several colleagues contacted me about a comment
It happens more often than you might expect. One topic I often speak about is patient notices. Don’t we all love them? We all know
The program aims to lower drug costs and improve affordability for Americans with Medicare. The Centers for Medicare & Medicaid Services (CMS) has released initial
Providers need to know their appeal rights and be prepared to exercise them. The other day I read an article about Medicare Advantage (MA) audits.
With little fanfare, CMS posted data for 2019 RAC activity – and the results weren’t pretty. Let me start today with a thanks to all
Providers need to fight for their patients in ways the insurance companies don’t. Medicine is both an art and a science, not a game. Screening
HCC scores also don’t predict costs (or payments). EDITOR’S NOTE: This is the second and final article in a two-part series about Hierarchical Condition Category
The Association has filed a lawsuit against the federal No Surprises Act. The Texas Medical Association (TMA) is challenging a 600-percent hike in administrative fees
One Quality Improvement Organization (QIO) gave the wrong information, costing a hospital thousands of dollars. First, let me thank all of you who have been
The GAO cites deficiencies in the HHS program’s response to past PHEs. Just last week, the Government Accountability Office (GAO) took a significant step by
A highly publicized UHC denial of care led to more questions than answers. By now many have read the ProPublica expose on how UnitedHealthcare (UHC)
Understanding precisely what the phenomenon of “ED boarding” means is vital to managing proper placement of patients. I was recently asked by Christine in Minnesota
Familiarize yourself with the dramatic 2023 changes to codes, coding guidelines and documentation requirements for evaluation and management (E&M) split/shared and incident-to services.
Dr. Ronald Hirsch breaks down significant 2023 changes to coding and billing requirements for hospital observation services, including new physician E&M coding rules.
Learn how to save your facility hundreds of thousands of dollars in repayments and fines by correctly following CMS requirements for implantable medical device credit reporting. We provide you with all the need-to-know protocols, along with the steps for correct compliance while offering best practices to implement a viable strategy in your facility.
During an exclusive RACmonitor webcast, healthcare attorney Knicole Emanuel will explain in simple, easy-to-understand language the peril of the coming overpayment audits and describe your legal defenses.
Do you struggle with selecting and appending the correct modifier for your medical claims? Join our must-attend webinar, “Mastering Modifier Usage: Preventing Denials and Ensuring Compliance” to reduce claim denials and improve your reimbursement rates.
Kay Piper reviews the guidance and updates coders and CDISs on important information in the AHA’s fourth quarter 2023 ICD-10-CM/PCS Quarterly Coding Clinic in an easy to access on-demand webcast.
Get access to important guidance on each of the AHA‘s 2023 ICD-10-CM/PCS Quarterly Coding Clinics with information-packed on-demand webcasts available shortly after each official publication.
Gloryanne Bryant reviews the guidance and updates coders on information in the AHA’s third quarter 2023 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Kay Piper reviews the guidance and updates coders on information in the AHA’s second quarter 2023 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Gloryanne Bryant reviews the guidance and updates coders on information in the AHA’s first quarter 2023 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Why should you be focused on SDOH data and ICD-10-CM Z codes? How can you integrate the capture of these elements into your workflows? Get guidance now — before new CMS assessment and reporting mandates take effect.
Set yourself up for appeal success with knowledge about the legitimate presentations of acute heart failure, the common vulnerabilities that auditors identify, the challenges clinical teams face, and how to write a concise and compliant validation query.
What are the changes to the IPO and ACS lists for 2023? What auditor trends do you need to watch out for in the new year? Don’t be caught off guard. Register today for this essential regulatory update led by Dr. Ronald Hirsch.
Take away tried-and-true strategies for ensuring that your Utilization Review committee is working effectively
A massive task lies ahead! Now’s the time to start preparing your case management and utilization review teams for successful implementation of changes contained in the 2023 IPPS, OPPS and MPFS rules.
Learn how to achieve complete, accurate documentation that establishes medical necessity and how to differentiate between billable and non-billable services.
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