One might presume that entities contracted by the federal government to provide oversight of healthcare would be intimately familiar with the rules of the game.
You have questions, we have answers. EDITOR’S NOTE: On Jan. 24, RACmonitor published a special bulletin authored by Dr. Hirsch on the manual changes to
Litigation is targeting the QPA, and its designation as the going rate for out-of-network providers. A number of provisions from the No Surprises Act took
Reports suggest that about 25-40 percent of readmissions are preventable. Hospitals already suffering from the financial hemorrhage of the COVID pandemic will be hit again
Overlapping extrapolations require providers to pay twice. Some Medicare auditors have been caught “double-dipping,” the practice of sampling and extrapolating against the same set of
Funding is imperative to address the emerging focus on health disparities. On Jan. 11, the National Institutes of Health (NIH) posted a significant funding opportunity
Healthcare providers are now required to ensure that workers either are vaccinated or obtained an exemption. Last month, I noted that the U.S. Department of
The changes will become effective in about three months, giving providers time to modify processes. The staff at the Centers for Medicare & Medicaid Services
Ownership questions persist and remain controversial. Recently we have been involved in several discussions regarding who “owns” the chart: the medical record. I really didn’t
Clinical trials for the medication showed no significant improvement in patients. Last week was a big week for those afflicted with Alzheimer’s disease, as the
Large employers will not have to enforce a mandate, but healthcare entities will. Last Thursday, the Supreme Court said yes to one of the Biden
A five-year study looking at 7,900 home health agencies revealed interesting disparities. The Journal of Rural Health published a recent article by the New York
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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