For nearly a decade after the late-2000s Centers for Medicare & Medicaid Services (CMS) policy changes, work Relative Value Units (RVUs) felt like a stable
Hospitals across the country are facing mounting financial pressure from Medicare Advantage (MA) plans. One increasingly common tactic used by MA payers is systematic downcoding:
Monitor Mondays listeners know that I end each segment with a song. Normally the topic drives the song, but to start the new year, the
EDITOR’S NOTE: The author of this article used AI-assisted tools in its composition, but all content, analysis, and conclusions were based on the author’s professional
EDITOR’S NOTE: This article was originally published Monday, Dec. 8 by RACmonitor as a special bulletin. Many people are still seething mad about Aetna’s devious
On Nov. 21, the U.S. Department of Justice (DOJ) announced that Dr. Ameet Vohra and his company, Vohra Wound Physicians Management, one of the nation’s
The Medicare audit landscape has undergone a fundamental transformation, evolving from ad hoc enforcement practices to scientifically rigorous methodological frameworks. This evolution spans two critical
It’s two weeks into November, and still no Outpatient Prospective Payment System (OPPS) Final Rule from the Centers for Medicare & Medicaid Services (CMS). Now,
The federal government may have shut down, but there has been no pause for the 340B drug pricing program. The more than 1,600 safety-net hospitals
Can we talk for a moment? As an educator, I’m obligated to insist that there are no stupid questions. As a physician advisor who works
As we conclude National Case Management Week 2025 with the theme of “Guiding Journeys,” we are making a point of celebrating case management professionals who
We all know now that the federal telehealth waivers were allowed to expire while Congress continues the stalemate over the budget. And in the Centers
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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