When I was a teenager, my father established the rules of the house. He sometimes referred to them as “guidance” or “clarifications.” One day he
As a provider, a question worth asking yourself these days is this: what degree of risk is there that you might have something on your
In the post-public health emergency (PHE) era, I have noticed what I think may be a glitch in the computer system at the Centers for
When hiring consultants or compliance or legal professionals, ego, often insecurity in disguise, can cause big trouble. People who feel a strong need to prove
An oncology practice I work with recently called with a challenging question: what do we do with a patient who acted in a threatening manner?
A client received a letter requesting a wide range of billing and coding information, and copies of variety of medical records before it concluded “please
Back in June, the Centers for Medicare & Medicaid Services (CMS) released a memo titled “Requirements for Hospital Discharges to Post-Acute Care Providers,” which was
Today’s first topic is an update to something I reported about on Monitor Mondays back in 2017: a U.S. Department of Health and Human Services
I have to admit, I am still upset at David Glaser for hiding the fact that last week was a new moon – and using
Whenever there is an extrapolated audit, we tend to attack it on two fronts. We hire an expert statistician to debunk the extrapolation, and a
Sometimes, life is predictable. Eclipses are a great example. (You should plan on seeing the next total solar eclipse, on April 8, 2024! It’ll be
If you have heard me speak or have read my articles you know that one of the questions most asked is “what is the target/benchmark/right
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.
Artificial intelligence is rapidly transforming healthcare revenue cycle operations, from coding and auditing to compliance and denials. Join industry leaders Pam Warren (MaineHealth) and Raemarie Jimenez (AAPC) for a live fireside chat exploring how AI is changing workflows, workforce roles, payer-provider dynamics, and compliance risk—and what organizations should be doing now to prepare.
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.
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