The for-profit payer business model is, at its core, simple math. The goal is to make a profit for investors/owners. In the first article of
The Health Resources and Services Administration, however, did received $1 billion for programs to improve maternal and child health. Congress passed a $1.5 trillion spending
The president’s initiative on mental health would require insurers to cover three mental health visits a year, at no cost to members. President Joe Biden
Medicare Advantage plans are being buffeted by bad news and regulatory challenges. Last week produced a lot of Medicare Advantage (MA) news. Retired municipal workers
Latest lawsuit is one of four targeting the controversial legislation. Oral arguments were heard a little over a week ago on the Texas Medical Association
New initiatives capture attention on Capitol Hill. New this week: the rebirth of one sweeping health policy, the presumed death of another, and a hint
Ownership questions persist and remain controversial. Recently we have been involved in several discussions regarding who “owns” the chart: the medical record. I really didn’t
Clinical trials for the medication showed no significant improvement in patients. Last week was a big week for those afflicted with Alzheimer’s disease, as the
This is what providers can expect in 2022 in the form of new technology audits. During 2022, healthcare providers will see more options to exploit
Changes to the MPFS, OPPS, and HHPPS were announced on the same day. Rather than a “news dump” late on a Friday afternoon, federal healthcare
Summary highlights from the ACPA’s NPAC 2021 conference: “Advising in an Unconventional World.” The Centers for Medicare & Medicaid Services (CMS) continues to create confusion
There is an acute exacerbation of angry patients occurring at this time. EDITOR’S NOTE: RACmonitor will be producing an occasional series on this problem in
Stay ahead of Medicare Advantage’s 2025-2026 regulatory changes in this critical webcast featuring expert Tiffany Ferguson, LMSW, CMAC, ACM. Learn how new CMS rules limit MA plan denials, protect hospitals from retroactive claim reopenings, and modify Two-Midnight Rule enforcement—plus key insights on omitted SDoH mandates and heightened readmission scrutiny. Discover actionable strategies to safeguard revenue, ensure compliance, and adapt to evolving health equity priorities before the June 2025 deadline. Essential for hospitals, revenue cycle teams, and compliance professionals navigating MA’s shifting landscape.
Struggling with CMS’s 3-Day Payment Window? Join compliance expert Michael G. Calahan, PA, MBA, CCO, to master billing restrictions for pre-admission and inter-facility services. Learn how to avoid audit risks, optimize revenue cycle workflows, and ensure compliance across departments. Critical for C-suite leaders, providers, coders, revenue cycle teams, and compliance teams—this webcast delivers actionable strategies to protect reimbursements and meet federal regulations.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals. Don’t miss this chance to protect your hospital’s revenue and reputation!
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. HIM coding expert, Kay Piper, RHIA, CDIP, CCS, provides an interactive review on important information in each of the AHA’s 2025 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
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