Weighing the difficult decisions being made in the business of healthcare. Medicine has commonly been considered one of the most altruistic professions. From long years
Patients “managed” out of benefits on Medicare Advantage programs. Administrative overhead for Medicare fee-for-service operations typically runs at approximately 2-3 percent. Overhead for commercial insurance
CDI professionals can’t mitigate the magnitude of medical necessity denials by third-party payers. Clinical documentation integrity (CDI) programs, combined with the actions of third-party payers,
Planning is underway now for ICD-11. The American Health Information Management Association (AHIMA) has been getting involved in the development of ICD-11 through its participation
Consider your health in your travel plans. The Pan American Health Organization (PAHO), which is in Washington D.C., is reminding travelers to get vaccinated if
Not knowing the difference could amount to shortchanging yourself. It seems like the simpler the question, the harder it can be to answer. When we
Can we code 93655 in addition to 93653 when the initial arrhythmia was atrial tachycardia (AT) in right atrium but then an atrial flutter (atypical) was discovered in the left atrium? Technically, this is a different arrhythmia; however, if both were solo, would they both map to the same 93653?
Is there a bilateral code for x-rays of the first toe on the left foot and the fourth toe on the right foot?
What are the conditions for an oral anti-cancer drug to be covered under Part B?
Can respiratory therapists (RTs) perform smoking and tobacco-use cessation counseling services for Medicare patients? Since the RTs really don’t submit claims, can the hospital bill a technical component if the services are performed by an RT under physician order (i.e., under the Medicare incident-to policy)?
Does the hospital still have the option to bill Medicare for the test if all of the conditions for the new laboratory DOS exception are met?
Which IV hydration codes are potentially impacted by a proposed RAC audit?
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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