When Extrapolations Were Being Vacated
Frank Cohen, MPA
October 12, 2022
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
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
A timely update on the NSA and the AEOB. In August, the administration published the final final rule on the No Surprises Act’s Independent Dispute
The Centers for Medicare & Medicaid Services are levying civil monetary fines for non-compliant hospitals. The feds are going after hospitals they believe are not
The newsletter reveals a startling revelation. Last week Kepro, the BFCC-QIO (Beneficiary and Family Centered Care Quality Improvement Organization), hereafter referred to as “QIO”) for
Double-dipping has been seen among some Managed Care Organizations. How many readers have undergone more than one audit? What about more than one audit for
Although the Biden Administration claims this is the final regulation, there is evidence more is yet to come. The Biden administration released the final No
The FAQ released recently yields information on the Independent Dispute Resolution. The FAQs related to the No Surprises Act final rule was released last week. Just
The Inflation Reduction Act and the No Surprises Act both impact seniors. Last week, both the House and the Senate passed the Inflation Reduction Act
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 decision last week by a Federal Appeals Court could impact the False Claims Act. The Eighth Circuit Court of Appeals, which covers states in
Appeal rights appear much narrower than many expected. Earlier this year, a federal appeals court issued an opinion on Barrows v. Becerra, a long-running class
It started out as a $4 trillion infrastructure package; but nearly a year and a half later, Biden’s Build Back Better initiative is now a
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.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
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