Often, the ability to move such a patient from the hospital into an appropriate setting is dependent on the social services in the local jurisdiction.
Medicare does not provide funding for financial losses. When natural disasters strike, Medicare and Medicaid audits become less important, and human safety becomes most important.
Rumors persist of possible leadership changes at some Medicare Advantage plans in the mid-South region. From where I sit, which is very close to the
CMS used secret shoppers to call phone numbers advertised on television and discovered a lot of incorrect information and attempts by the agents to coerce
A recent survey has illustrated just how onerous the various federal regulations of healthcare have become. If you’re feeling extra productive and accomplished this morning
Hospitals and health systems are increasingly turning to innovative methodology to cope with staffing and budget constraints. Utilization review (UR) has been in place for
Always challenge the extrapolation. It is my opinion that extrapolation is used too loosely in healthcare audits. What I mean is that sample sizes are
Two key insurers were recently targeted for HHS OIG scrutiny. I was all set to dive into the September audits of HumanaChoice and BlueCross Blue
Quality reporting will be mandatory in 2024, and then under a payment determination in 2026. Last week I reported on the social determinants of health
A close look at three extrapolation case histories. When the COVID-19 pandemic first hit in 2020, many folks assumed that it would not be an
There are 50 Shades of Grey in federal prepayment review. I hate wishy-washy laws. If a law exists, in my mind, it should be specific.
Well, it appears I opened a real can of worms last week when I mentioned a DRG downgrade audit finding received by a hospital for
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.
Fraud convictions don’t just punish a few bad claims; they can wipe out years of reimbursements. Don’t wait for an audit to learn the rules. Join Frank Cohen, MPA, for a live Q&A on spotting red flags, avoiding liability, and protecting your practice. Register now and bring your questions!
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.
This first session in our 2026 IPPS Masterclass will feature an in-depth explanation of FY26 changes to ICD-10-CM codes and guidelines, CCs/MCCs, and revisions to the MCE, presented by 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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