Audits in Medicare and Medicaid are designed to uncover improper billing, overpayments, or fraud. The process typically involves a detailed review of healthcare claims and
The temporary disappearance of key public data sets, including the Atlas Tool and the Youth Risk Behavior Surveillance System, has raised significant concerns among data
Are you sick of me writing about the Medicare Change of Status Notice (MCSN) yet? Too bad! Many of you continue to challenge me with
With the 2025 legislative sessions in full swing by this point, I wanted to give everyone a glance at one of the hottest topics in
It is all too common for patients and physicians to take to social media to air grievances about insurance company misdeeds. A recent case generated
This week I would like to address myths about multiple-choice physician queries that persist, despite guidance from the American Health Information Management Association (AHIMA) and
I am so grateful to have the opportunity to use this platform and my Talk Ten Tuesdays segment, “My Talk,” to shine a spotlight on
President Donald Trump recently issued an executive order titled “Ending Radical and Wasteful Government DEI Programs and Preferencing,” aiming to dismantle diversity, equity, and inclusion
While we think of Oct. 1 as the date we look for new ICD-10 codes and changes, in the past few years we have seen
When performing flow cytometry for cell enumeration, should CPT® codes 88184 or 88185 ever be reported separately, or are these inherently bundled? Additionally, if a pathologist provides a distinct interpretation of the flow cytometry results, is there any scenario where CPT codes 88187-88189 could be reported separately, or is the interpretation always included in the procedure?
A respiratory therapist provides a brief smoking cessation counseling session lasting two minutes during a patient’s outpatient visit. The provider also bills an evaluation and management (E/M) service for the encounter. How should the counseling service be reported, and is it separately billable under codes 99406–99407?
When performing an MRI on a patient with an implanted cardiac device or neurostimulator, how should code 76018 be reported if the same provider conducting the device evaluation or neurostimulator analysis programming also prepares the device for MR safe mode? Would this scenario still qualify for separate reporting of 76018, or must a different provider perform the additional preparation for it to be billed?
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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