I am sure by now that many of you have heard the news that there is an ongoing criminal investigation into UnitedHealthcare’s Medicare Advantage (MA)
A new wave of Recovery Audit Contractors (RACs) and Unified Program Integrity Contractors (UPICs) have swept across the nation, empowered to root out fraud in
The Centers for Medicare & Medicaid Services (CMS) is proposing targeted changes to the Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP) in the fiscal
Grab your pens, alert your billing teams, and cue up your electronic medical record (EMR) vendors, because the Centers for Medicare & Medicaid Services (CMS)
Let’s start today with a report that five Florida hospitals are suing Leapfrog Group over their receiving poor ratings. The hospitals, all part of Tenet,
Like many of you, I am deathly allergic to clinical documentation integrity (CDI), but do not worry; I premedicated with prednisone and an antihistamine prior
Price transparency in healthcare has long been a stated priority for the Trump Administration, both the first and second, and several recent public moves have
Although specifics remain under negotiation, early outlines and House resolutions suggest that Medicaid will face significant reductions, likely through a combination of structural funding changes
Let me start with a wild Medicare Advantage (MA) denial of inpatient admission. This was a 75-year-old male who fell. The patent had chronic atrial
Let me start with a topic that was discussed by David Glaser during a recent Monitor Monday broadcast. He noted the federal regulation (42 CFR
EDITOR’S NOTE: Following last Monday’s Monitor Monday Internet broadcast, the U.S. Department of Health & Human Services (HHS) posted new guidance and an online portal,
Editors Note: This article was originally published on ICD10monitor, April 15, 2025 In a sweeping policy shift, the Centers for Medicare & Medicaid Services (CMS)
RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.
Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.
Fraud convictions don’t just punish a few bad claims; they can wipe out years of reimbursements. Don’t wait for an audit to learn the rules. Join Frank Cohen, MPA, for a live Q&A on spotting red flags, avoiding liability, and protecting your practice. Register now and bring your questions!
Substance abuse is everywhere. It’s a complicated diagnosis with wide-ranging implications well beyond acute care. The face of addiction continues to change so it’s important to remember not just the addict but the spectrum of extended victims and the other social determinants and legal ramifications. Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating substance abuse in 2025. Register today and be a part of the conversation!
Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals. Don’t miss this chance to protect your hospital’s revenue and reputation!
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. HIM coding expert, Kay Piper, RHIA, CDIP, CCS, provides an interactive review on important information in each of the AHA’s 2025 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
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