Always challenge the extrapolation. It is my opinion that extrapolation is used too loosely in healthcare audits. What I mean is that sample sizes are
The good, the bad and the ugly in healthcare news reporting. It is time for another multi-topic update. Some weeks produce just too much news
Five priorities are identified in the mission of CMS Office of Minority Health, “Working to Achieve Health Equity.” The Centers for Medicare & Medicaid Services
The application of precision medicine, along with diagnostic testing, is expected to save billions of dollars. The patient has cancer. Difficult to treat. An available
Five years ago, the Centers for Medicare & Medicaid Services (CMS) first compiled a list of services that the newly implemented recovery audit contractor (RAC)
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
The fate of these hospitals looks grim. Rural hospitals have long been considered “on the edge.” They typically serve populations that are old, less affluent,
Overcoming the Medicare Advantage bullies. It is a well-known fact that denials are increasing exponentially. The commercial payers, especially the Medicare Advantage Organizations (MAO), have
New guidance follows a report to CMS by the OIG on Medicare Advantage Organization’s inpatient clinical criteria in denying claims. EDITOR’S NOTE: This story is
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
Aside from fraud and abuse associated with telehealth, the future of this technology is astonishingly bright and innovative. Responding to COVID-19, the Department of Health
How many times have we panelists talked about COVID and COVID exceptions to the regulatory rules? How many times have we warned providers that the
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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