For just about every common denial reason, there is a viable defense. Here are a few. Auditors can be overzealous, resulting in both civil and
Healthcare facilities are rapidly becoming overwhelmed with an influx of new patients who have contracted the highly contagious COVID variant. If you’re confused by the
A recent study showed that some common orthopedic procedures aren’t routinely supported by data. As I am sure others will note, Jan. 1 marked the
Audit and regulatory challenges that were ever-present in years past only seem primed to increase over the new year. The long-awaited implementation of the Inpatient
This is what providers can expect in 2022 in the form of new technology audits. During 2022, healthcare providers will see more options to exploit
LETTER FROM THE PUBLISHER – DECEMBER 2021 – Dear Colleague, You and I have experienced a sea change this past year in our world of
Annual overdose deaths are creeping toward and beyond six figures. Rising opioid-related emergency department visits, overdoses, and deaths: this issue has re-emerged with a vengeance
Federal healthcare audits are back with a vengeance following a brief COVID-related pause. In August 2020, the Centers for Medicare & Medicaid Services (CMS) was
The issue is far from settled legally, as challenges to the hold loom in two federal appeals courts. Since the onset of the pandemic, many
The prevalence of audits is soaring after the expiration of COVID-related regulatory relaxation. Despite the strain that hospitals and health systems are facing with the
Federal oversight of healthcare is changing, with a greater emphasis on equity and consumer rights. In this first year of the new administration, we saw
Shifting trends among healthcare auditors means one thing in particular for providers: they have to stay on their toes. Continued improper payment rates and high
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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