This article will feature one part poll, one part legal discussion. First, the poll: do you have the sense that administrative law judge (ALJ) hearings
Medicare audits against healthcare providers may violate federal statutes and strip away the due-process rights guaranteed under the U.S. Constitution. How does this happen? We
The new rule also highlights how bad some auditors can be at explaining when offering a provider a rare bit of good news. Earlier this
The OIG claimed that 71 of 333 inpatient claims did not meet Medicare criteria for inpatient status. A recent report, titled “CMS Can Use OIG
A close look at three extrapolation case histories. When the COVID-19 pandemic first hit in 2020, many folks assumed that it would not be an
If overpayments are found, then the extrapolation recoupment number will go up; if underpayments are found, the extrapolation will go down. Precision matters – in
High Court ruling raises questions concerning ALJ appointments. A sneaky and under-publicized matter, which will affect every one of you reading this, slid into common
The appellate court reversed the decision of the ALJ. When you defend an overpayment finding by a Recovery Audit Contractor (RAC) or a termination of
Lack of auditor response leads to an ALJ hearing. “A stitch in time saves nine” is a pretty famous heuristic expression, but most people I
New case law supports due process for Medicare providers. Due process is one of the cornerstones of our society. Due process is the universal guarantee
OMHA adds Chapter 14 to its case processing manual The Office of Medicare Hearings and Appeals (“OMHA”) has recently been updating its OMHA Case Processing
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),
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
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