Well, I gave you all a break from my criticism of insurance company policies and ploys last week, and I had planned to go for
Some of you may have noticed that I am not always very nice to some insurance companies. And deservedly so. But I also point out
Election Day finally arrived – however, some physicians may not be celebrating the new 2025 Medicare Physician Fee Schedule (PFS) Final Rule that also arrived.
The day after Halloween, there were no treats for doctors. The Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule Final
Few topics crop up in our articles more often than the Two-Midnight Rule. While it is frequently discussed and debated, I would posit that few
With a week off, I have much to report today to catch up. First, many of you may have heard or read that Medicare has
Despite the Two-Midnight Rule passing its 11-year mark, there’s still confusion about when to place an inpatient order for patients initially placed in outpatient status
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has posted a report titled Additional Oversight of Remote Patient Monitoring
Rule 9(b) of the Federal Rules of Civil Procedure states that, in all averments of fraud, such as allegations concerning the False Claims Act, (FCA)
“Inattentional blindness” is a fancy term to describe a very real compliance risk. There’s a great video illustrating the problem which will appear at the
I want to thank Millie in Florida to pointing out something very important that happened last week which affects more than 300 hospitals around the
Healthcare providers participating in the Medicare and Medicaid programs face an intricate web of regulations and enforcement actions. Disputes with state officials over payment practices,
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
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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.
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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.
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