Targeted Probe-and-Educate (TPE) audits resumed on Sept. 1. Everyone in the industry knows about audits of healthcare providers. But what about the billing companies? Or
Many states are implementing payment parity on a permanent basis. Every time a regulation is revised, Medicare and Medicaid audits are altered…sometimes in the providers’
Audits for meaningful use can equal tens of thousands of dollars. Today I want to discuss electronic health records (EHRs) and Recovery Audit Contractor (RAC)
Three provider defenses reside within the SSA. To defend against Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), or Targeted Probe-and-Educate (TPE) audits, we always
While utilization of upper-level visit codes will continue to increase, risk will likely remain stable., There has been so much in the way of education,
The CMS budget for fraud, waste and abuse has doubled in size from 2021 to 2022. Two years ago, the federal government created a plan
Expect more audits for this setting. Hello, and happy birthday, Medicare and Medicaid. You are now 56 years old. In other words, you’ve been qualified
Alleged overpayment and audit findings in violation the Jimmo settlement. Today I will be writing about a settlement agreement between the Centers for Medicare &
Certainly, audits are a growing source of concern, but there is no need for panic if you are adequately prepared. The topic of audits has
Strategies for increasing revenue and litigating on behalf of clients. There are two ways to increase revenue merely by ensuring that your patients’ rights are
In-person hearings are back – at least in most states. 2020 was an odd year for Recovery Audit Contractors (RACs) and Medicare Administrative Contractors (MACs).
Federal contractors are paying particular attention to payment for COVID care. It’s time to revisit a prediction regarding COVID-related audits. Months ago, it was proposed
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.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
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