The Two-Midnight Rule and Condition Code 44
John Zelem, MD, FACS
May 25, 2022
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
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
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
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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