UnitedHealth says it will use proprietary software to deny claims. EDITOR’S NOTE: The topic of this article was previously covered by RACmonitor on separate occasions
Coding Guidelines and Conventions trump Coding Clinic. Hats off to coders. This group of medical information professionals is required to master one of the most
Issues abound in prominent payer coding guidance. By now, many hospitals have received denials for emergency department level-of-care coding. We could legitimately ask, “how did
A complex process is simplified in a tabular comparison. Not infrequently, in the process of utilization review (UR), we run into situations in which, as
AMA’s changes are complementary to the CMS proposed changes to this code set. The Centers for Medicare & Medicaid Services (CMS) is moving quickly on
Emergency departments (EDs) have been a hot-button topic in the battles over “surprise” billing. Certainly, many patients use EDs inappropriately. We’ve all read and heard
Homelessness continues to be a compliance issue. Homelessness is a population health crisis. Doing nothing is not an option. Hospitals following existing law and best
Highlights of the 2019 Medicare Physician Fee Schedule, released on Nov. 1, are provided by the author. There will be no change in E&M payment
EDITOR’S NOTE: The following article was originally published on the American College of Physician Advisors (ACPA) blog by the author. I never really understood how
The government of Puerto Rico’s official Hurricane Maria death toll at 2,975. The 2017 hurricane season devastated entire regions of the globe, especially states and
Understanding the proposed CMS “Add-on” codes and their impact on reimbursement. In Part I in this article series, I discussed the proposed changes to the
Are procedure payments in jeopardy? While most of the attention to the 2019 Physician Fee Schedule proposed rule is focusing on the evaluation and management
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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