The proposed documentation changes will require retraining an entire industry. EDITOR’S NOTE: The public comment period for the 2019 proposed MPFS closes Monday, Sept. 10,
How much does Medicare pay for an evaluation and management (E & M) service assigned with a modifier 25?
With calcium scoring, 76376 is bundled; however, 76377 can be assigned with a modifier. My radiologists always do the reformation of images for these studies on a separate workstation. With proper documentation, can I assign the following code on those studied?
76377 3D rendering with interpretation and reporting of computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation
Will Medicare issue payment when the main reason for a patient’s visit is to receive an injection?
If more than one inhalation treatment for acute airway obstruction is performed on the same date of service, do we report 94640 with a modifier?
Is it appropriate to bill for a 3D post-processing charge (76377) for the computer-aided detection (CAD) portion of the prostate magnetic resonance imaging (MRI) since the computer generates a 3-D model to calculate perfusion curves?
When analyzing multiple genes (a panel) for simultaneous reporting, should a single code be used or multiple Tiers 1 and 2 codes?
OMHA Issues Updates to Its Case Processing Manual The Office of Medicare Hearings and Appeals (OMHA) announced updates to its OMHA Case Processing Manual (OCPM),
Filing marks shift in nature of healthcare litigation of this nature. The whistleblower cases I report on for RACmonitor typically are brought by the quintessential
The government of Puerto Rico’s official Hurricane Maria death toll at 2,975. The 2017 hurricane season devastated entire regions of the globe, especially states and
I have whined in a previous RACmonitor enews article about how the importance given to the admission order in today’s healthcare industry makes absolutely no
The proposal is on the table as part of proposed E&M changes. EDITOR’S NOTE: The following story was published by RACmonitor on Aug. 16, 2018.
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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