Observation, outpatient outlier payments, and the Inpatient-Only List: Getting it right is not always easy. On this week’s Monitor Mondays we had a robust discussion
Efforts should be undertaken to audit Medicare payers, since it’s not always providers who commit fraud. Today I am going to write about America’s managed
Are you using something other than two-midnight? Here’s why you shouldn’t be. Is there the possibility that your utilization management team and physician advisors are
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.
How to stay compliant with code 44. This is certainly a topic that could result in literally hours of presenting, as there is a lot
Don’t keep your doctor in the dark. It can be tempting to exaggerate the risk of practice as a means to encourage compliance. But it is
Observation volumes continue to stress hospitals. The utilization process is very difficult and complicated. We must continue to advocate for our elders and
With Medicare regulations, there appears to be no right answer. A recent discussion on an Internet user group asked the question, “is there any wiggle
The prepayment review is the equivalency of the American legal tradition that holds “you’re guilty until proven innocent.” It’s hard enough to be one
The errors identified through coding audits really are a lesson to learn. EDITOR’S NOTE: This article first appeared in the RACmonitor edition of the Saturday
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
It’s important to remember that Medicare manuals are not binding, and they can’t “require” anything, including signatures. A few weeks ago, I wrote an article
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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