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
New round of audits coming to providers relative to the PRF program. The U.S. Department of Health and Human Services (HHS) recently announced an additional
CMS inserted regulatory language in 42 C.F.R. § 410.20(e) indicating that they loosened the signature requirement. Sometimes, the desire to save money by skipping legal review
A number of COVID-related stories emerged this week that are worth following up on. First, earlier this month, the U.S. Department of Health and Human
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
Ownership questions persist and remain controversial. Recently we have been involved in several discussions regarding who “owns” the chart: the medical record. I really didn’t
For just about every common denial reason, there is a viable defense. Here are a few. Auditors can be overzealous, resulting in both civil and
Healthcare facilities are rapidly becoming overwhelmed with an influx of new patients who have contracted the highly contagious COVID variant. If you’re confused by the
Are you part of the problem or the solution? EDITOR’S NOTE: In a two-part series, physician-attorney Dr. John K. Hall will explore routine findings that may
Physicians in general are not trained to think this way, but may be forced to do so in the very near future. During the early
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.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
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