Medicare beneficiaries are likely to reap some benefits from the new legislation. The Inflation Reduction Act is a topic that is different from what I
A recent headline, and an older book, offer cautionary tales. The NBC News headline, “Florida hospital ignored years of complaints about surgeon, patients and families
A reader responds to the CMS request for feedback on ways to strengthen Medicare Advantage plans. EDITOR’S NOTE: On Aug. 1, 2022, the Centers for
When the Centers for Medicare & Medicaid Services (CMS) implemented the Patient Driven Payment Model (PDPM) as the new reimbursement method for skilled nursing facilities
The recent episode of Monitor Mondays’ lead story prompts a deeper assessment of the ecomonic plight of bigness is the U.S. This week’s Monitor Monday
The Code may be used less often than some but is very frequently improperly applied. Condition Code 44 is probably the least understood and possibly
Observations, questions and answers during a week of pontification. So what’s new this week? In a previous Monitor Monday, I mentioned the recently released 2022
If overpayments are found, then the extrapolation recoupment number will go up; if underpayments are found, the extrapolation will go down. Precision matters – in
Increased nurse salaries have eaten away at many facilities’ bottom lines. You’ve heard of audits for regulatory compliance, right? What about audits for how money
There is a growing expectation that consumers will have avoided 12 million surprise billing claims in this first year of the law. We’ve just passed
The devil is in the details for this OIG report. Last week the OIG released a report entitled “A Quarter of Medicare Patients Experienced Harm
Happy National Nurses Week! When I was a resident in general surgery years ago, I was frequently told that my best friends would be the
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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