Today, I want to talk about secret, hidden RAC audits. As you are probably aware, federal regulations limit RACs from going back more than three
As I reported last week for RACmonitor, Livanta released a newsletter about short inpatient stays at the end of July. Their case examples were, to
Today’s first topic is an update to something I reported about on Monitor Mondays back in 2017: a U.S. Department of Health and Human Services
Laboratories are suddenly under scrutiny by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) and state Medicaid departments. Labs
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
Whenever there is an extrapolated audit, we tend to attack it on two fronts. We hire an expert statistician to debunk the extrapolation, and a
Sometimes, life is predictable. Eclipses are a great example. (You should plan on seeing the next total solar eclipse, on April 8, 2024! It’ll be
Hospitals may be the most complex organizations in the world. They are tasked with improving patient outcomes, controlling costs, and meeting sustainable environmental goals. The
Revenue cycle management (RCM) has never been more important to the success of healthcare providers across the care spectrum, but the industry faces myriad challenges.
Today, I’m writing about skilled nursing facilities (SNFs). The Centers for Medicare & Medicaid Services (CMS) recently directed the Medicare Administrative Contractors (MACs) to audit
Lately, I have been inundated with Medicare and Medicaid healthcare providers getting audited for evaluation and management (E&M) codes. I know Dr. Hirsch (Ronald Hirsch,
When the federal Public Health Emergency (PHE) ended on May 11, many of the waivers that kept external audits in check also vanished. As a
The CMS Two-Midnight Rule and short-stay audits are here to stay, impacting inpatient and outpatient admissions, ASC procedures, and Medicare Parts C & D. New for 2024, the Two-Midnight Rule applies to Medicare Advantage patients, requiring differentiation between Medicare plans affecting Case Managers, Utilization Review, and operational processes and knowledge of a vital distinction between these patients that influences post-discharge medical reviews and compliance risk. Join Michael G. Calahan for a comprehensive webcast covering federal laws for all admission processes. Gain the knowledge needed to navigate audits effectively and optimize patient access points, personnel, and compliance strategies. Learn Two-Midnight Rule essentials, Medicare Advantage implications, and compliance best practices. Discover operational insights for short-stay admissions, outpatient observation, and the ever-changing Inpatient-Only Listing.
A massive task lies ahead! Now’s the time to start preparing your case management and utilization review teams for successful implementation of changes contained in the 2024 IPPS, OPPS and MPFS rules.
Gain clarity on billing, patient notifications, and discharge appeal rights in social admissions. Join our webcast for essential insights and strategies to navigate this complex landscape, ensuring financial stability and optimal patient care.
Dr. Ronald Hirsch provides tried-and-true strategies and insight into outpatient in hospital bed stays including determining the applicable definition, who uses it, and when and how to bill for this circumstance, solidified with concrete case examples and expert insight.
Explore comprehensive guidelines and best practices for secondary diagnosis coding in our illuminating webcast. Delve into the intricacies of accurately assigning secondary diagnosis codes to ensure precise medical documentation. Learn how to navigate complex scenarios and adhere to coding regulations while enhancing coding proficiency. Our expert-led webcast covers essential insights, including documentation requirements, sequencing strategies, and industry updates. Elevate your coding skills and stay current with the latest coding advancements so you can determine the correct DRG assignment to optimize reimbursement, support medical decision-making, and maintain compliance.
Enhance your inpatient coding precision and revenue with Principal Diagnosis Coding: Mastering Selection and Sequencing. Join our expert-led webcast to conquer the challenges of principal diagnosis selection and sequencing. We’ll decode the intricacies of ICD-10-CM guidelines, equipping you with a clear grasp of the rules and the official UHDDS principal diagnosis definition. Uncover the crucial role of coding conventions, master the sequencing of related conditions, and confidently tackle cases with equally valid principal diagnoses.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY24 Inpatient Prospective Payment System (IPPS) Final Rule, including new ICD-10-CM/PCS codes, plus insights, analysis and answers to questions from the country’s most respected subject matter experts.
This third session in our 2024 IPPS Summit will feature a review of FY24 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by senior healthcare consultant Laurie Johnson, with bonus insights and analysis from two acclaimed subject matter experts
This second session in the ICD10monitor 2024 IPPS Summit will feature a review of the FY24 changes to ICD-10-PCS codes and New Technology Add-On Payments, presented by senior healthcare consultant Laurie Johnson, with bonus insights and analysis from CDI expert Dr. Erica Remer. CMS has published approximately fifty new applications to New Technology Add-On Payments and you don’t want to leave money on the table!
Our 2024 IPPS Summit will get you up-to-speed on the many changes to ICD-10-CM codes and guidelines, SDoH and CCs/MCCs, plus the revisions to the MCE for the coming year, all while providing valuable insights and analysis from top subject matter HIM and CDI experts.
Boost your coding accuracy and contribute to quality care! Join our webcast on Patient Safety Indicators (PSIs), HACs, and POA status. Discover trouble spots to watch out for and key terms in your medical record documentation. Elevate your skills to ensure precise code assignment and make a meaningful impact on hospital care. Don’t miss this opportunity to enhance your coding expertise!
This expert-guided webcast will showcase tips for providers to ensure appropriate capture of the work performed for a visit. Comprehensive examples will be given that demonstrate documentation gaps and how to educate providers on the documentation necessary to appropriately assign a level of service. You will gain clarification on answers regarding emergency department and urgent care coding circumstances as well as a review of how/when it is appropriate to code for E&M in radiology and more.
Practical solutions for CDM departments to protect your hospital’s revenue.
This webcast teaches hospitals how to comply with CMS price transparency rules and compare their rates with peer hospitals. It covers creating a compliant machine-readable file, comparing negotiated rates, and improving pricing decisions.
The No Surprises Act (NSA) presents a challenge for hospitals and providers who must provide Good Faith Estimates (GFEs) for all schedulable services for self-pay and uninsured patients. Compliance is necessary, but few hospitals have been able to fully comply with the requirements despite being a year into the NSA. This webcast provides an overview of the NSA/GFE policy, its impact, and a step-by-step process to adhere to the requirements and avoid non-compliance penalties.
Familiarize yourself with the dramatic 2023 changes to codes, coding guidelines and documentation requirements for evaluation and management (E&M) split/shared and incident-to services.
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