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
Now more than ever it’s no time to cut corners. EDITOR’S NOTE: This article is an expansion of the original piece, “CoP Compliance in the
Hospital medical records are under scrutiny by the Centers for Medicare & Medicaid Services. Via two unrelated changes, the Centers for Medicare & Medicaid Services
While the introduction of new COVID-19 reimbursement rules and regulations have brought on their share of confusion, there is one certainty healthcare organizations can bank
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
CMS offers advice through its Medicare Learning Network Connects bulletin to avoid coding errors. Mistakes happen, and errors do occur in the coding industry. The
Most compliance decisions involve balancing risk. EDITOR’S NOTE: The following is a summary of a recent broadcast segment on Monitor Monday by the author. Generally
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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