Eight key guidelines for ensuring proper coding. EDITOR’S NOTE: The following is a summary of a presentation by Margaret Skurka during the 2017 American Health
Proprietary algorithm to determine “correct” code and change claim. It’s clearly a new age in the coding of emergency department (ED) visits – after all,
If a physician begins a cholecystectomy procedure using a laparoscopic approach but has to convert the procedure to an open abdominal approach, which approach would be reported?
Is the coding of a diagnostic cardiac catheterization different based on the access into the body, for example: radial versus femoral artery?
Last week you gave a list of options that a referring lab must meet to be able to bill for clinical lab tests on the CLFS. We are interested in the one about the lab not referring more than 30 percent of the tests for which it receives testing requests, etc. How does CMS determine the 30 percent exception option?
How do you code for diffusion-tensor imaging (DTI) and diffusion-weight¬ed imaging (DWI) when they are performed with magnetic resonance imaging (MRI) of the brain? Are there specific codes to describe this imaging?
Is whole blood covered under Medicare’s incident-to policy?
Would the documentation of snoring and signs of nasal obstructions be enough reason to do a polysomnography?
The lawsuit was filed as an alleged violation of the federal False Claims Act. A recently unsealed federal whistleblower lawsuit alleges that dozens of Indiana
Rural healthcare models for assisting Alzheimer’s Disease patients are profiled in this report on the impact of the disease on America’s rural health population. November
Treating a heart attack as outpatient may sound ludicrous, but for some hospitals it may be the right choice. The two-midnight rule threw the hospital
As use of EHRs increases, so too does the potential for fraud. The use of electronic health records (EHRs) is expanding at a rapid pace,
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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