Maryland Total Cost of Care (TCOC) Model was developed by the CMS Innovation Center. Maryland is different from every other state when it comes to
More audits are coming, how do we stay compliant? We have been saying it but now it is happening. More audits are coming your way.
The final rule is expected to be posted on the first Friday in August. The Centers for Medicare & Medicaid Services (CMS) has released the
Remember that just because a MAC says it, doesn’t mean it is true. It seems reasonable to expect Medicare Administrative Contractors (MACs) to make sure
There must be rules and appeal rights for terminations. The pandemic rules/exceptions may be coming to an end on April 16, 2022. For example, as
Both initiatives speak to patient-centric care. EDITOR’S NOTE: Stanley Nachimson, a former CMS career professional, is a popular presenter on Talk Ten Tuesdays. The Accountable
Thanks to new provisions that went into effect for the 2022 calendar year, CMS is no longer necessarily considering “nefarious intent” when determining whether a
The story below is true and represents all that is wrong with the appeals options. EDITOR’S NOTE: RACmonitor is continuing its series “RAC Rants,” wherein
Until CMS or Congress acts, we are forced to continue with this concatenation of cost-to-charge ratio calculations, leading to high charges and more media attention.
Reports suggest that about 25-40 percent of readmissions are preventable. Hospitals already suffering from the financial hemorrhage of the COVID pandemic will be hit again
The changes will become effective in about three months, giving providers time to modify processes. The staff at the Centers for Medicare & Medicaid Services
For most readers the results of this analysis will be amazing but true. EDITOR’S NOTE: Longtime RACmonitor contributor and R1 Physician Advisory Services Vice President
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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