When considering coding protocols, it’s vitally important to differentiate between “requirements” and “recommendations.” In June I did a Monitor Mondays segment and a RACmonitor article
Documentation should be concise information, justifying the acuity of an inpatient level of care when appropriate. Statements that physician documentation needs improvement are always being
The allegations in the case focused on CCs and MCCs. EDITOR’S NOTE: This story appeared Aug. 20, 2019, in the ICD10monitor news. A Texas federal judge
Initial round of audits proves successful for therapy providers. Therapy providers in the Novitas JL jurisdiction have received good news on the initial round of
The scoring mechanisms of the MDM are suggested tools, not rules or laws. In our last article we explored how time in conjunction with medical
Providers must document the complexity of care for each and every patient. There is a standard misunderstanding of the utilization of time-based documentation and billing.
Pending a possible government shut down, this bill would allow documentation from a home health agency to be considered when records are reviewed. Late on
A quietly introduced rule change should relieve burden on teaching physicians. How many weeks has it been since I have been critical of the Centers
In the aftermath of the devastation caused by both Hurricanes Harvey and Irma, the Centers for Medicare & Medicaid Services (CMS) has issued blanket waivers
The June 21 issue of RACmonitor introduced a discussion of the peril of placing blind trust in expert reviews focusing on surgical coding issues. In
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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