A longtime RACmonitor contributor has three different topics on his mind this week. Let’s start with the good news. It looks like we will be
The anticipated issue date for the new audit is the 2024 fiscal year. Citing “consistently high error rates,” federal officials announced this week that
Release of the REH designations for 2023, indicates that CMS will only be covering outpatient, emergency, and observation care services. Last Tuesday, the U.S. Department
A close look at three extrapolation case histories. When the COVID-19 pandemic first hit in 2020, many folks assumed that it would not be an
The proposed rule is designed to reduce red tape associated with enrollment in Medicaid and related programs. In a move that some might surmise as
Complaints are abundant from beneficiaries. Last week saw the release of another audit of a Medicare Advantage (MA) plan from the U.S. Department of Health
The week of July 11 was one that was full of regulatory excitement. As expected, the U.S. Department of Health and Human Services (HHS) extended
The enforcement arm of the federal health department has been busy, with more than 300 criminal enforcement actions in six months. Of any unsavory traits
There must be rules and appeal rights for terminations. The pandemic rules/exceptions may be coming to an end on April 16, 2022. For example, as
In a stunning move, the U.S. Department of Health and Human Services (HHS) just announced that it is eliminating the need for providers to have
Information is provided in a breakdown of the annual HHS-DOJ fiscal report. On July 27, the U.S. Department of Health and Human Services (HHS) and
The final sum is slightly greater than the FY 2018 total. The federal government won or negotiated more than $2.6 billion in healthcare fraud adjustments
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
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