Pharmacy Question for the Week of January 1, 2018
Under the OPPS, what’s included in payment for drugs and biologicals?
Under the OPPS, what’s included in payment for drugs and biologicals?
Does the physician have to be in the room for the hospital to bill a barium swallow (74230)?
Can we separately report endoscopic procedures that are performed on two regions of the respiratory system with different types of endoscopes?
Is modifier -59 (distinct procedural service) or modifier -XU (unusual non-overlapping service) better to use for a diagnostic cardiac catheterization that led to a decision to place a coronary stent at the same session?
What is the Medicare policy for packaging of laboratory tests?
For some, palliative care could be the greatest gift during the holiday season. Most people are familiar with the 1946 classic Christmas movie ‘It’s a
The CMS announcement will be discussed in a conference call on Jan. 9, 2018. Healthcare providers and suppliers with fewer than 500 appeals pending at
How should modifier 91 be reported under the National Correct Coding Initiative (NCCI) program?
During a recent transcatheter mitral valve repair (TMVR), we used three prostheses. Can we assign code 33418 plus 33419 x 2?
What are the OPPS rates for new codes 94617 and 94618 for exercise and stress testing?
If I receive a bundling message that says something is included in a service billed on the same day and I do not find evidence of this edit in the latest version update of the National Correct Coding Initiative (NCCI), who should I ask about this denial?
What is the appropriate CPT® code for magnetic resonance imaging (MRI) internal auditory canals (IACs)?

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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