Got denials? This article is about building relationships between hospitals and payers. Hospitals in our country are currently taking one or more of the
Compliance and fines are two things that go together in healthcare. The environment for imposing those fines and issuing exclusions for individuals or companies that
FEATURING Janelle Ali-Dinar, PhD; Nancy Beckley, MS, MBA, CHC; Bret Bissey, MBA, FACHE, CHC, CMPE; William Dombi, Esq.; Sara Goldstein, Esq.; Ronald Hirsch, MD, FACP,
How are RACs paid?
What codes are available for smoking cessation counseling visits?
How do we bill out a myocardial perfusion scan that is performed over a two-day period? Does it get billed out on the date it is started or on the day it is finished?
In Addendum B of the hospital OPPS, I see several different SIs listed for drugs. What do these letters indicate?
If a treating physician orders an automated hemogram (CPT code 85027) and a manual differential WBC count (CPT code 85007), can both codes be reported for Medicare patients?
We were told we should bill code 96374 for administration of LUMASON® (sulfur hexafluoride lipid-type A microspheres) for injectable suspension, for intravenous use or intravesical use with echocardiogram with contrast, but we are getting denials for this code. Is there another code we should use?
For those compliance officers and leaders looking for another way to educate or influence their colleagues and decision-makers about the need for proactive and effective
EDITOR’S NOTE: On Tuesday of this week, news media organizations were reporting that U.S. intelligence officials delivered a report to both President Barack Obama and
In its Dec. 9, 2016 report, “Vulnerabilities Remain Under Medicare’s Two-Midnight Hospital Policy,” the U.S. Department of Health and Human Services (HHS) Office of Inspector
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.
This Memorial Day, we honor those who gave all for our freedom. Take 20% off sitewide through May 29 with code MEMORIAL26 at checkout
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
