The voices calling out for a “patient-centric care model” are either rapidly fading or are being drowned out by the noises of poor payment, preauthorization,
How often have you heard, when getting Medicare data, “that does not include Medicare Advantage (MA) data in that report.” MA, now representing over 50
Just before Congress adjourned for 2023, lawmakers sent another in a series of letters to the Centers for Medicare & Medicaid Services (CMS) expressing “serious
Mergers and acquisitions in healthcare markets are viewed with heightened scrutiny by the Federal Trade Commission (FTC) and U.S. Department of Justice (DOJ) Antitrust Division.
I often emphasize the importance of choosing your words carefully, and today I’d like to do that in the context of what is often called
Today I want to write about one of our current hot-button topics: artificial intelligence, better known as AI. First, I want to pose the question:
At the start of a new year, it is traditional to forecast what will happen in the next – but I’ve been around long enough
How many times have we heard horror stories surrounding the billings of 99204 versus 99205? We all know that the definitions of E&M codes were
Like most of the world, I procrastinate when paying my bills. I tend to put them off until the very last minute. And that pretty
Would you like to know the enrollment data for Medicare Advantage (MA) members in your county, and/or for your facility? Go to this website: https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data
My most recent article focused on issues surrounding imposter government agents. This week, let’s focus on the real thing. Let’s say a U.S. Department of
In light of Medicare finally forcing big pharma to do what it has to do and negotiate drug prices, I want to talk about a
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
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