I was fortunate to obtain excerpts from an appeal letter submitted by a hospital in response to a Medicare Advantage (MA) denial from Humana. The
Two years ago, President Biden signed into law a transformative piece of legislation – the Inflation Reduction Act, marking a historic effort to lower healthcare
There’s a good chance frequent Monitor Monday listeners have heard me discuss the four Texas Medical Association (TMA) lawsuits at least once over the last
The government lies. And now I have testimony proof. I know I have discussed my North Carolina administrative grievance regarding the dentists, oral surgeons, and
In an interview earlier this year, the top official at the U.S. Department of the Office of the National Coordinator for Health IT (ONC) noted
At this point we probably shouldn’t be surprised by the Roberts Supreme Court’s willingness to eviscerate precedent in the name of strict textualism. On the
Recently, the U.S. Department of Justice (DOJ) issued a press release announcing a massive nationwide healthcare fraud bust, creating the types of headlines designed to
An unprecedented number of individuals are now enrolled in Patient Protection and Affordable Care Act (PPACA) Marketplace health insurance plans – and federal officials this
EDITOR’S NOTE: In an earlier version of this article, which has since been corrected, two inaccuracies were noted. TEFCA was introduced by the U.S. Department
The U.S. Department of Health and Human Services (HHS), in collaboration with the Centers for Medicare & Medicaid Services (CMS) and the Substance Abuse and
Today I am going to do something a little different. I am going to write about outpatient care in a bed from the regulatory side,
EDITOR’S NOTE: This is a fictional story that could become much too real. In the bustling corridors of General Hospital USA, the heart of the
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
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