Idaho has one of the lowest vaccination rates in the country. EDITOR’S NOTE:b The total U.S. coronavirus death this morning, Thursday, Sept. 9, 652,675. RACmonitor
Providers offering the shot to multiple residents in one home setting or communal setting will now be eligible for multiple boosted payments. Federal officials are
The suits allege that defendant Kaiser Permanente inappropriately inflated reimbursement applications for Medicare Advantage beneficiaries. In a titanic legal battle over healthcare reimbursement, a prominent
Through the annual announcement, CMS said it is also turning its focus to “sustainability and readiness.” Federal officials hope that the Inpatient Prospective Payment System
The Centers for Medicare & Medicaid Services (CMS) has issued the Final Rule for inpatient rehabilitation facilities (IRFs) that takes effect Oct. 1. The rule
Medicare payment policies and rates are set to be adjusted for the 2022 fiscal year as a result of the moves. The Centers for Medicare
In an unprecedented move, the Centers for Medicare & Medicaid Services (CMS) has proposed in the 2022 Outpatient Prospective Payment System (OPPS) Rule to put
EDITOR’S NOTE: Former CMS official Matthew Albright, now a legislative consultant for Zelis and a RACmonitor contributor and Monitor Monday’s panelist, will continue his reporting
The defendants were charged in seven district courts spanning the country. The locations of the seven U.S. Attorney’s Offices that this week brought healthcare fraud
Brooks-LaSure will become the first Black person to lead the federal agency responsible for the administration of the Medicare and Medicaid programs. The federal agency
CMS says the proposed rule is intended to enhance medical workforce in rural and underserved communities. Long-awaited and eagerly anticipated the Centers for Medicare &
The federal holiday honoring King is annually held on the third Monday in January. The executive body of a prominent nationwide healthcare organization has issued
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
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.
Expert presenters Kathy Pride, RHIT, CPC, CCS-P, CPMA, and Brandi Russell, RHIA, CCS, COC, CPMA, break down complex fracture care coding rules, walk through correct modifier application (-25, -57, 54, 55), and clarify sequencing for initial and subsequent encounters. Attendees will gain the practical knowledge needed to submit clean claims, ensure compliance, and stay one step ahead of payer audits in 2026.
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.
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