There are basic steps to follow when creating an effective contingency plan. In any crisis, emergency, or pandemic, which do happen from time to time,
In an unprecedented move, the Centers for Medicare & Medicaid Services (CMS) has released 15 documents specifying new waivers in response to the COVID-19 pandemic.
Long-awaited and highly anticipated, providers hope other payers will follow suit. Healthcare insurer giant UnitedHealthcare (UHC) has announced that it will be suspending prior authorization
Rural America is facing a healthcare crisis. EDITOR’S NOTE: The global pandemic of the coronavirsus is further exacerbating the rural health crisis. This is the
List of resources for front-line professionals. Everyone is coping with the new norm imposed by COVID-19, with those at risk for the social determinants of
Testing a limited number of random people, we can reach conclusions within a certain probability. Statistical analysis is a funny thing. It turns out that
Not all waivers are created equal. Last week’s article briefly discussed the Emergency Medical Treatment & Labor Act (EMTALA). Here is a more detailed discussion. The legal
EDITOR’S NOTE: Dennis Jones is the Administrator of Patient Financial Services for Montefiore Nyack Hospital in Nyack, N.Y., about 20 miles north of New York
March 23, 2020—The Centers for Medicare & Medicaid Services (CMS) has clarified its position on the use of swing beds, saying that swing beds can
The regulatory landscape is rapidly changing in the wake of the coronavirus. EDITOR’S NOTE: As with last week, RACmonitor asked Dr. Ronald Hirsch, vice president
The uncomfortable truth about the coronavirus pandemic? A near-total and indefinite shutdown of American life is probably just the beginning. EDITOR’S NOTE: Veteran RACmonitor
On March 13, the Centers for Medicare & Medicaid Services (CMS) issued blanket waivers that will impact Inpatient Rehabilitation Facilities (IRFs) as well as other
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.
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.
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.
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.
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.
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.
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