Home – RACmonitor

Claims

When Inpatient Claims Are Impacted by Outpatient Services

This week, let’s focus on coding guidelines associated with reporting diagnoses occurring during an outpatient visit subject to the Medicare Three-Day Payment Window Rule. Remember, the inpatient hospital claim must include all the diagnosis and procedure codes that meet the Three-Day Payment Window requirements. Therefore, emergency department (ED) services, observation

Cheryl Ericson, RN, MS, CCDS, CDIP July 7, 2025

AHA

The Coming Crisis: How Medicaid Provider Tax Restrictions Threaten Hospitals in Red States

Hospitals across the United States face mounting financial strain from Medicaid underpayments, but red states – those with Republican-majority legislatures and governors – stand to

Timothy Powell, CPA, CHCP July 7, 2025

Documentation

Revenue Integrity in a Value-Based World: The Role of HIM Professionals

The shift from fee-for-service to value-based care (VBC) is reshaping how healthcare organizations are reimbursed and evaluated. In this new environment, success hinges not only

Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P July 7, 2025

Documentation

DRG Downgrades by Commercial Payers: Documentation Defense Tactics

In the current climate of cost containment, commercial payers are increasingly downgrading MS-DRGs after claims are submitted, not disputing the need for inpatient care, but

Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P June 30, 2025