CMS is encouraging the integration of healthcare providers so that their size is increased to have averaged payments represent a break-even or better. CMS (the
Providers should consider how to optimize the patient’s health status prior to discharge to hospice. In his RACmonitor article of Aug. 8 regarding the recent
In FY 2019, hospital performance in the HRRP will be assessed relative to hospitals within the same peer groups. Since 2013, Medicare has penalized hospitals
2019 IPPS removes requirement for authentication of admission orders prior to discharge. EDITOR’S NOTE: This is the second and final installment of a two-part series.
CMS provides Medicare waivers for providers dealing with natural disasters. I live in North Carolina, and as most of you have seen on the news,
CMS continues to help hospitals impacted by the aftermath of Florence No sooner had Monitor Monday signed off on Monday’s program with live reports from
2019 IPPS removes requirement for authentication of admission orders prior to discharge. EDITOR’S NOTE: This is the first installment of a two-part series. When the
RAC issue for IRFs has moved from being proposed to being approved. The Centers for Medicare & Medicaid Services (CMS) recently posted a potential Complex
Once a denial is issued, a P2P will no longer be an option. An astute physician advisor recently brought to my attention a change to
Is CMS preparing to slash payments for procedures with 10- and 90-day global periods? While thousands of doctors have submitted mostly unfavorable comments to the
Not enough information in the public use databases to know that a claim is fraudulent. “In God we trust; all others bring data.” That is
If approved, reviews would impact RAC Regions 1 through 4 in all states. In November 2017, the Centers for Medicare & Medicaid Services (CMS) announced
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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