Providers should be aware of these emerging strategies for defending against audits. For years, providers have been plagued with defending claims for medically necessary services
Crime doesn’t pay, but it’s costing headaches for many. The COVID-19 vaccination program has stimulated one of the largest crime waves in history – and
Proposals were made during recent Coordination and Maintenance Committee. The healthcare industry has consistently asked when ICD-10-CM codes will better address the social determinants of
Why doesn’t CMS use business intelligence to catch fraud? You can call it business intelligence. You can call it common sense. As Medicare pays fee-for-service
The head of a group of Michigan- and Ohio-based pain clinics and other providers will also have to pay $51 million in restitution. Federal officials
The report underscores federal authorities’ recent assertions that coding errors are generating ample unwarranted reimbursement. EDITOR’S NOTE: This article was originally published by ICD10monitor on
More covered health services and more policing under the Biden administration. President Biden’s healthcare policies differ starkly from those of former President Trump’s, and I
New AHIP report touts Medicaid MCO action for SDoH. While pressure continues for states to rein in costs associated with health and behavioral health, strategies
Silo thinking is also not a learned trait. It is actually engrained in our thinking from early life. In clinical revenue cycle, there are several
Drug overdose deaths were another influencer. Amid last week’s hottest reports was new data from the National Center for Health Statistics. While it was expected
In this case, more than 50 percent of the practice’s patients refuse to provide an email address or do not have one to provide. Recently,
The Medicare IPO list was doomed years ago. For readers of and listeners to RACmonitor and Monitor Mondays, overthinking things is what we do. It’s
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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