RAC Audits Under Scrutiny
Knicole C. Emanuel Esq.
July 13, 2022
Learn how MACs piggyback on RAC audits. A question that I get often is “Do I have to submit the same medical records to my
Learn how MACs piggyback on RAC audits. A question that I get often is “Do I have to submit the same medical records to my
For the last 30-plus years, MedLearn has earned and maintained a reputation for reliability in the mercurial and unpredictable world of coding and compliance. In
2023 Official Coding and Reporting Guidelines for ICD-10-CM are effective with discharges/visits on Oct. 1, 2022. The Centers for Medicare and Medicaid Services (CMS) released
New payment rules include a proposed rule to establish a new provider type Rural Emergency Hospitals (REHs). We have now reached the second half of
New guides become effective Oct. 1, 2022. It’s time to review the Official Guidelines for Coding and Reporting for fiscal year 2023. These take effect
Emphasis is on relieving the administrative burden placed on physicians. In 2021, American Medical Association (AMA) CPT® Editorial Panel approved and published new documentation guidelines
The proposed rule includes expansions to the Physician Payment Schedule as well as a focus on access to high-quality care. The Calendar Year 2023 Physician
We received an order from a referring physician that requested an ultrasound (US) thyroid for nodule assessment and a US soft tissue for a submental mass palpable on the exam. The facility coder believes that the facility should get two charges. The interpretation covers both areas in one report. It is my understanding that head and neck (CPT® 76536) would cover both of these assessments. Am I correct? The evaluation is performed for two separate reasons, but the imaging is of the neck.
What are the differences between codes 75625 and 75630 for an abdominal aortogram?
Do you have any tips for reporting therapeutic ultrafiltration? What code would we use?
How do we determine when 88740 and 88741 should be billed separately or bundled? Do you have any advice?
When can you bill for a manual differential or a pathologist’s review of an abnormal smear?
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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