A recent ruling out of New York is the latest notable step in a very long-running saga involving alleged healthcare fraud by Omnicare, a Pharmacy
Let me start with a warning. Hardly a day goes by that we don’t hear a story about the wonders of artificial intelligence (AI). And
I have recently seen providers receiving notices of alleged overpayments for relatively small amounts, say $10,000 or $20,000. These figures might strike a provider as
Federal contractors – Recovery Audit Contractors (RACs) and Unified Program Integrity Contractors (UPICs) – have increasingly targeted wound care claims, particularly involving expensive skin substitutes
My association, 340B Health, represents hospitals that participate in the federal 340B drug pricing program. It has been an incredibly busy summer, with many new
Let me start with a recently published audit of a home care agency, Sunflower Home Health in Cleveland Mississippi. During a two-year audit period, the
The Trump administration has recently announced what it’s calling a “digital health ecosystem” that will allow for millions of Americans to upload personal health data
January 2024 marked a significant change for the application of the Two-Midnight Rule for Medicare Advantage (MA) plans, when the Centers for Medicare & Medicaid
1. Payment & Reimbursement Changes For Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) site-neutral payments, the Centers for Medicare & Medicaid
Last week, President Trump unveiled his administration’s Artificial Intelligence (AI) Action Plan for America, a sweeping, 90‑point policy initiative aimed at securing U.S. dominance in AI
Let me start this article by asking for your help. Flash back to 2013. The Centers for Medicare & Medicaid Services (CMS) at that time
The Proposed Rule on the Medicare Physician Fee Schedule (MPFS) for the 2026 fiscal year is out, and if adopted, it’s got very good news
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
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.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
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.
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