The Centers for Medicare & Medicaid Services (CMS) is once again proposing to eliminate the inpatient only list starting in January 2026, repeating the process
Today, in utilization news, there is a warning to any surgeons who may be reading this – or anyone who works with surgeons. You may
Healthcare reimbursement operates on a fascinating paradox: physician services aren’t paid based on market rates or simple invoices, but on calculated values derived from estimated
Grab your pens, alert your billing teams, and cue up your electronic medical record (EMR) vendors, because the Centers for Medicare & Medicaid Services (CMS)
Some of you may have read my article from last week kindly published as a special bulletin. For those who did not, let me recap.
Election Day finally arrived – however, some physicians may not be celebrating the new 2025 Medicare Physician Fee Schedule (PFS) Final Rule that also arrived.
This week my report will be a little different. I am going to tell the story of a family friend’s medical journey. My wife’s friend,
In 2021, the Centers for Medicare & Medicaid Services (CMS) released a completely revamped version of the evaluation and management (E&M) codes, primarily for the
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
EDITOR’S NOTE: Listen to Dr. Ronald Hirsch as he makes his Monday Rounds on Monitor Mondays, this coming Monday, Jan. 8 at 10 a.m. EST.
Well, I’ve got a couple of updates for you in the absolute roller coaster that is the No Surprises Act’s Independent Dispute Resolution (IDR) process!
The new CPT® books are out, and they include a discussion about shared visits. Pamela Schulman (a Monitor Mondays listener) asked a great question: “How
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.
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.
Master the FY 2027 ICD-10-CM changes, including new diagnosis codes, CC/MCC updates, and coding guideline revisions, with practical insights from nationally recognized coding and CDI experts.
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