“PAYGO” (Pay-As-You-Go) refers to a budget enforcement rule designed to impose fiscal discipline: when lawmakers pass legislation that increases mandatory spending or reduces revenue without
In honor of National Case Management Week, I am covering a topic that, while a repeat, is so widely misunderstood (particularly by government contractors!) that
You know, sometimes I wonder if the topics I discuss in these articles are just theoretical concepts, encompassing scenarios that never actually happen. That’s the
Hello, and a very happy National Case Management Week to all of you! Every case manager out there, nurse or social worker, has had to
As we conclude National Case Management Week 2025 with the theme of “Guiding Journeys,” we are making a point of celebrating case management professionals who
When a patient leaves the hospital against medical advice (AMA), the discharge is not only a clinical concern, but it can also create coding and
Someone recently asked on LinkedIn if they must always sequent a UTI as the principal diagnosis when encephalopathy due to a urinary tract infection (UTI)
September is the annual Suicide Prevention Month which is also a reminder to examine our coding considerations. In March of this year, the Centers for
Mandatory vs. discretionary spending Antideficiency Act “exceptions” Under the Antideficiency Act (which prohibits federal agencies from incurring obligations without appropriations), there are certain exceptions that
If a patient has rheumatoid arthritis and comes in for a methotrexate injection, do we use the chemotherapy injection code?
Is it possible to report biliary stenting codes (47538, 47539, 47540) more than once per session?
What revision was made to the description of CPT code 94640 in 2016?
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.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
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