Two key insurers were recently targeted for HHS OIG scrutiny. I was all set to dive into the September audits of HumanaChoice and BlueCross Blue
Swing beds are a practical solution for rural hospitals with fewer than 100 beds. By John Zelem, MD, FACS Unless you have been exposed to
There are some key 2023 CPT® Evaluation and Management (E&M) Code changes for Home and Residence Services. EDITOR’S NOTE: The American Medical Association (AMA) announced
The process involves a multi-step review. Physicians take the Hippocratic Oath in medical school to “do no harm.” Despite their best intentions, however, many physicians sometimes
The series begins today on Talk Ten Tuesday with ChristianaCare. The Agency for Healthcare Research and Quality (AHRQ) is the lead federal agency under the
Is follow-up angiography separately billed when performed with intracranial embolization? Do you have any other tips for reporting 75898 or 61624?
Does additional time affect the assignment for code 95816?
Can we report 88380 in conjunction with 88381?
What is the key distinction between a standard CT and a CTA?
Usually, we instruct coders that if three-dimensional (3D) reconstruction of images is not described in the medical report, it is appropriate to code for a CT study and not a CTA study. This situation most often arises when physicians dictate notes following a CT of the chest for pulmonary embolism. Often physicians identify such a study as a CTA because during the study they are looking at vessels, but such a study is not really a CTA for coding purposes. When coding a CTA of the abdominal aorta with runoffs (code 75635), if the coder does not see a dictation specifying that a 3D postprocessing technique was used, should the coder code for a CT of the abdomen with contrast, a CT of the right leg with contrast, and a CT of the left leg with contrast? The 3D requirement for a CTA study when coding abdomen with runoff creates an issue if the physician does not document a 3D postprocessing technique.
In the changing landscape of healthcare, new legal problems are emerging with health insurance companies potentially violating the No Surprises Act. The controversy centers around
Quality reporting will be mandatory in 2024, and then under a payment determination in 2026. Last week I reported on the social determinants of health
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.
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.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
This third session in our 2026 IPPS Masterclass will feature a review of FY26 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.
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