There is a growing expectation that consumers will have avoided 12 million surprise billing claims in this first year of the law. We’ve just passed
Observation, outpatient outlier payments, and the Inpatient-Only List: Getting it right is not always easy. On this week’s Monitor Mondays we had a robust discussion
Benefits are largely dictated by how each state manages its Medicaid program. The MACPAC (different from the RACs, or Recovery Audit Contractors) stands for the
Efforts should be undertaken to audit Medicare payers, since it’s not always providers who commit fraud. Today I am going to write about America’s managed
Some new credit agency reporting rules can make it impossible for physicians to collect legitimate patient amounts due. The No Surprises Act is big news.
It’s time to consider the use of artificial intelligence to respond to requests for copies of records. When we hear “release of information,” we usually
Medicare post-payment audits are estimated to have risen over 900 percent over the last five years. Let’s talk about post-payment audits – or, specifically, Recovery
If a patient had a G-tube, D-or J-tube, or G-J tube previously and needs a new one placed through a new access, would this be coded as a replacement?
What is an external biliary drainage catheter?
Can we use flow cytometry codes to report absolute cell counts (not requiring interpretation)?
Can imaging guidance for central venous access catheter or device placement be separately reported?
What happened with codes 93720–93722 for plethysmography? We keep getting denials when we try to use these codes.
Our interventional cardiologist performed a PTCA in the LAD, an atherectomy in the RCA, and placed a drug-eluting stent in the left circumflex artery (LC). How would we code for this?
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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