General Question for the Week of May 8, 2023
Bryan Nordley
May 8, 2023
Can 96521 be reported for chemotherapy pump refills?
Can 96521 be reported for chemotherapy pump refills?
Urinary therapeutic procedure coding is inherently complex; each code comes with its own nuances and areas of potential confusion. Given the multitude of codes involved,
SNFs now have a golden opportunity to speak up about an issue that prevents many patients from accessing their care. We are now about a
While everyone is familiar with the notion that doctors practice medicine, did you know it extends to administrative decision-making as well? Hospital utilization and billing
In March, the U.S. District Court in the Northern District of Texas vacated the requirement that Patient Protection and Affordable Care Act- (PPACA)-compliant health plans
Last week, the Centers for Medicare & Medicaid Services (CMS) gave itself a very bad report card on how it did during the first year
The federal statute 42 CFR § 482.30, in the Conditions of Participation for Utilization Review (CoP), requires that each hospital must have in effect a
The Centers for Medicare & Medicaid Services (CMS) just issued the above proposed rule—Managed Care Access, Finance and Quality. Before digging into the rule, I
I recently engaged in a fascinating discussion with Dr. Jake Martin on the “Top 10 Key Components of An Effective CDI Program,” involving thoughts on
This article is about spring cleaning your coding and billing! There are a few concerns coming to light that need tidying up. These include the
Can we report the gross and microscopic examination of prostate biopsies taken during a traditional transrectal ultrasound procedure with 55760?
CMS CRUSH (Comprehensive Regulations to Uncover Suspicious Healthcare) signals a new era of data-driven program integrity oversight that extends far beyond coding and CDI. As federal scrutiny of claims, documentation, billing practices, provider enrollment, and payment accuracy intensifies, healthcare organizations must be prepared to identify and address vulnerabilities before they result in audits, denials, repayments, or enforcement actions. Join us for this timely webcast to learn what CMS CRUSH could mean for your organization and discover practical strategies to strengthen documentation, claims integrity, compliance readiness, and reimbursement defensibility.
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.
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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