As required by their Statement of Work, Livanta, the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) for regions 2, 3, 5, 7, and 9,
Many of us eagerly, or with dread, await the yearly payment system rules that the Centers for Medicare & Medicaid Services (CMS) releases. Keeping up
Frequently, physician advisors are asked what value we bring to our facility. Physician advisors don’t produce billed services – a benchmark typically used by hospital
We have all heard it, time and time again. In fact, I recall telling my hospital’s chief medical officer that my patients were sicker than
Well, it appears I opened a real can of worms last week when I mentioned a DRG downgrade audit finding received by a hospital for
The good, the bad and the ugly in healthcare news reporting. It is time for another multi-topic update. Some weeks produce just too much news
There is nothing wrong with adjusting prices to fit your cost-to-charge ratio. New technologies have always posed a financial challenge to hospitals. While they want
MAOs use chart reviews to increase risk-adjusted payments is seen as inappropriate by the OIG. The U.S. Department of Health and Human Services (HHS) Office
Length of stay does not correlate directly with costs. I am sure many of you have heard me rant about observation rates before. I’m sure
CAR-T therapy could list a single service with a $1.4 million charge. I was honored to be able to speak at the annual meeting of
Providers should consider how to optimize the patient’s health status prior to discharge to hospice. In his RACmonitor article of Aug. 8 regarding the recent
Federal officials said the health system received overpayments of at least $2.4 million from 2014 through 2016. The University of Wisconsin Hospitals and Clinics Authority
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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