Implementation of the No Surprises Act – or NSA – continues to slowly but surely drive evolution of the healthcare landscape in the U.S. Central
Let’s start today with some Quality Improvement Organization (QIO) issues, specifically pertaining to Kepro. First, I reported a few weeks ago that Kepro is changing
Last week I wrote about the lack of adoption of the new evaluation and management (E&M) coding rules by physicians and urged all of you
Is there an arms race involving using technology for submitting claims and auditing them? In one example, an electronic health record system was deployed that
As one of the co-chairs of the recent National Physician Advisors Conference (NPAC) in Coronado, Calif., I had a front-row seat to all that unfolded
It has been nearly 40 years since the U.S. Supreme Court indicated in Chevron v. Natural Resources Defense Council that courts should defer to an
Last week was the National Physician Advisor Conference, and I want to thank all of those who stopped me and noted how useful they find
Since January 2021, the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS) Office of Inspector General
Citing a growing emphasis on the social determinants of health (SDoH), federal officials this week unveiled a Proposed Rule for inpatient and long-term care hospitals
First up, a totally unsubstantiated rumor. A Texas hospital has heard that one of their regional Medicare Advantage (MA) plans is going to start requiring
In a significant overhaul of Medicare Part D, set to take effect in 2025, beneficiaries are poised to experience a transformative change in how prescription
Recently, I was emailed a question from, presumably, a listener of Monitor Mondays. He wanted to know whether I had commented on the nationwide audits
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.
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.
Master the FY 2027 ICD-10-CM changes, including new diagnosis codes, CC/MCC updates, and coding guideline revisions, with practical insights from nationally recognized coding and CDI experts.
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